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2020 LAMOKA BAPTIST CAMP

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TABLE OF CONTENTS

Children’s Camp Safety Plan 3 Personnel 5 Facility Operation and Maintenance 9 Fire Safety 14 Medical Requirements 20 Supervision and Activity Safety 37 Orientation and Training 44 Campus Map 47 Evacuation Plan 48 Archery Safety Plan 50 Boating Safety Plan 53 Camp Trips Plan 61 Ropes, Climbing Wall, Zip Line Safety Plan 67 Sports Safety Plan 75 Swim Safety Plan 80 Activity Plan 107

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Children’s Camp Safety Plan

Camp Name: Lamoka Baptist Camp Camp Address: 3646 E Lamoka Lake Rd Tyrone NY 14887 Phone number: 607-463-0324 Prepared By: Greg Howard Title: Director/Administrator Email Address: Camp@lamoka.com

Signature: Greg Howard Date: 3/1/2019

New York State Sanitary Code Subpart 7-2, Children’s Camps, requires that children’s camp operators develop, review annually, update and implement a written safety plan. This plan must be submitted to the Local Health Department (LHD) or State District Office that has jurisdiction in the county or city where the camp is located for their review and approval. The plan must accurately describe the camp’s procedures for personnel, facility operation and maintenance, fire safety, medical, general and activity safety, staff training, and camper orientation. Camps may complete this document to fulfill safety plan requirements. Include any attachments (e.g. maps, schematics) as necessary. Once completed, it will serve as the camp’s comprehensive written safety plan. This plan must address the specific conditions of the camp and its operations, as well as serve as a training and reference document for camp staff. Local rescue, police and fire personnel should be consulted when developing the camp’s safety plan. LHDs may require additional information based on the camp’s operation, activities, and local requirements. Additional information may be obtained at www.health.ny.gov

Please send a copy to:

And, please retain a copy of this document for use at the camp.

For Health Department Use Only

Approved: ☐ Yes ☐ No Reviewer: Date: Comments:

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I. PERSONNEL Chain of Command Describe the camp's “Chain of Command.” A chain of command depicts an order of succession of responsibility/authority, which becomes particularly important when key staff are unavailable or unable to perform their assigned duties/responsibilities (if supervisory/evaluation responsibilities differ from the order below, show this information separately). An outline, similar to the diagram below, is an effective way to share this information during staff orientation.

☐ The above schematic accurately represents the camp’s chain of command.

☒ A chain of command schematic is attached separately.

☐ A chain of command schematic is described below: Staff Job Descriptions

* In the absence of the Camp Director, the Program Director will assume the Camp Directors responsibilities.

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Minimum qualifications and/or certifications for staff must meet State Sanitary Code requirements (7-2.5, 7-2.8, 7-2.11, 7-2.25) for age, certifications, experience, etc., for each position. Refer to Subpart 7-2 or the brochure “Requirements for Children’s Camps in New York State” for minimum staff requirements/qualifications and current “Fact Sheets” for accepted Aquatic, Cardiopulmonary Resuscitation (CPR) and First Aid certifications. The brochure and fact sheets can be obtained at www.health.ny.gov/environmental/outdoors/camps/ or from your local health department (LHD).

List the duties and responsibilities of each staff member. Staff titles listed below contain job duties and responsibilities critical to the operation of a children’s camp, which frequently relate to procedures in this plan. If a job duty or responsibility provided is not the responsibility of the identified staff title, list that duty or responsibility with the appropriate staff title. Camp Director – Duties and Responsibilities (check all that apply):

☒ Responsible for the overall operation of the camp. This can include but is not limited to staffing requirements, employee screening, program development, scheduling, supervision, and site evaluations at camp and trip sites.

☒ Ensure that camp maintains compliance with Subpart 7-2 (Children’s Camp Code).

☒ Oversee the implementation of the camp’s written safety plan.

☐ Other (list any additional duties/responsibilities): Camp Health Director – Duties and Responsibilities (check all that apply):

☒ Oversee the implementation of the written safety plan’s medical components.

☒ Supervise the health and sanitation at the camp.

☒ Review and maintain campers’ confidential medical histories.

☒ Oversee initial health screening of campers and daily surveillance of the camp occupants.

☒ Handle health emergencies and injuries, including emergency preparedness and follow-up for professional health care.

☒ Maintain the camp medical log.

☐ Other (list any additional duties/responsibilities): Counselors – Duties and Responsibilities (check all that apply):

☒ Supervise campers such that they are protected from any unreasonable risk to their health or safety, including physical or sexual abuse or any public health hazard.

☒ Maintain visual or verbal communications capabilities with campers during activities and account for assigned camper's whereabouts at all times.

☐ Other (list any additional duties/responsibilities): Aquatics Director

☐ N/A (No on-site swimming) Duties and Responsibilities (check all that apply):

☒ Oversee the implementation of the written safety plan’s swimming procedures.

☒ Establish and oversee all swimming activities at the camp, including off-site swimming.

☒ Supervise all staff and campers participating in swimming activities.

☒ Respond to waterfront emergencies.

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☒ Implement/oversee buddy system.

☒ If certified as a lifeguard, may serve as a lifeguard.

☒ If qualified as a Progressive Swimming Instructor, may assess camper’s swimming ability.

☐ Other (list any additional duties/responsibilities): Progressive Swimming Instructor

☐ N/A (No swimming activities) Duties and Responsibilities (check all that apply):

☒ Assess the swimming ability of each camper prior to allowing the child to participate in swimming activities.

☐ Other (list any additional duties/responsibilities): Qualified Lifeguard

☐ N/A (No lifeguards required) Duties and Responsibilities (check all that apply):

☒ Actively supervise participants in the camp's swimming activities as detailed in the camp's approved safety plan.

☒ Shall not be engaged in duties or activities that distract them from the direct supervision of the waterfront.

☐ Other (list any additional duties/responsibilities): Counselor-in-Training (CIT)

A CIT or Junior Counselor is a camper who is assigned to an on-duty counselor or other staff member to assist in performing specific duties. A CIT may not independently supervise campers, and shall be supervised as a camper. All CITs shall receive training specific to their duties, and camper orientation.

☐ N/A (CIT not used) Duties and Responsibilities

☒ Assist assigned staff member in performing the following duties (describe): In the table below, provide a job description for other staff titles, not listed above, that are utilized by the camp.

Job Title Duties and Responsibilities

Boat Driver Drives the boat. Has a PV license

Boat staff Responsible to put lifejackets on campers and facilitate boating.

Administrative secretary Responsible for office work and communication.

Cook Responsible to adhere to all children’s camp codes relating to the kitchen and foodservce. Oversees the making of food.

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Crafts Coordinator Responsible to oversee crafts.

Procedure for Verification of Staff Qualifications

Select all staff carefully! It is recommended that applications include questions regarding any past criminal convictions and current charges concerning a crime involving children. Evaluate the specific facts of the conviction or pending case against the prospective staff member and determine if employment as camp staff would involve an unreasonable risk to the safety or welfare of camp participants, the property, or the general public. Screen candidates in person (preferably) or by telephone interviews, asking questions about qualifications for the job and prior employment history, including experience working with children. The camp operator is also required to obtain and verify references on the character of all prospective camp staff. It is recommended to require references in writing from persons not related to the candidate and include questions specific to the candidate's experience with children, work history and reasons why the candidate would or would not be appropriate for the position. References should be verified by telephone. Interviews, reference questions, and responses must be documented, filed with employment applications at the camp, and available for inspection. In additional, camp operators must annually check the NYS Sex Offender Registry to determine if a prospective employee or volunteer at the camp is listed. A fact sheet, “NYS Sex Offender Registry Search Procedures” provides guidance on how to conduct a search of the Sex Offender Registry, and is available at www.health.ny.gov/environmental/outdoors/camps or from your local health department. Camps for Children with Developmental Disabilities (enrollment of 20% or more campers with developmental disabilities) must also check the Justice Center Staff Exclusion List (SEL) and the Statewide Central Registry (SCR). See the guidance document “Requirements for Camps for Children with Developmental Disabilities” available at www.health.ny.gov/environmental/outdoors/camps or from your local health department.

Indicate how staff qualifications and references are verified in addition to the mandatory checks above.

☒ Prior employment with camp

☒ Written applications

☒ Submittal of written references (specify number required): 3 (2 if they have worked under the current Camp Director)

☒ References checked by telephone

☒ Written references

☐ Past employer interviews

☒ Other (specify): Pastoral Reference (1 of the three references must be from a pastor of like-faith),

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II. FACILITY OPERATION AND MAINTENANCE

Potable Water Supply

How many water systems serve the camp? 1 Complete the following table for each water source:

Water Source Name and/or Number

Source Type On-Site Treatment Startup Procedure*

Pump House

☐ Year-Round

☒ Seasonal

☐ Off-Site Public

☒ On-Site Groundwater (Well)

☐ On-Site Surface Water (Lake/Reservoir)

☐ None

☒ Chlorination

☐ UV Disinfection

☐ Filtration

☐ Other:

☒ Startup Procedure A

☐ Startup Procedure B

☐ Startup Procedure C

☐ Startup Procedure D

☐ None (Year-Round)

☐ Year-Round

☐ Seasonal

☐ Off-Site Public

☐ On-Site Groundwater (Well)

☐ On-Site Surface Water (Lake/Reservoir)

☐ None

☐ Chlorination

☐ UV Disinfection

☐ Filtration

☐ Other:

☐ Startup Procedure A

☐ Startup Procedure B

☐ Startup Procedure C

☐ Startup Procedure D

☐ None (Year-Round)

☐ Year-Round

☐ Seasonal

☐ Off-Site Public

☐ On-Site Groundwater (Well)

☐ On-Site Surface Water (Lake/Reservoir)

☐ None

☐ Chlorination

☐ UV Disinfection

☐ Filtration

☐ Other:

☐ Startup Procedure A

☐ Startup Procedure B

☐ Startup Procedure C

☐ Startup Procedure D

☐ None (Year-Round)

* For seasonal water sources, obtain the “Acceptable Water Supply Start-up Procedures” from www.health.ny.gov/environmental/outdoors/camps/water_startup.htm or your local health department and include as an appendix to this document. Only use the start-up procedure appropriate for the potable water system type. Facility operators that annually disinfect on-site well(s) as part of their routine start-up procedures should use procedure “C Well Disinfection.” Who will be responsible for performing the annual start-up procedures for the water system?

☐ N/A (year-round water supply) ☒ Camp Director ☐ Head of Maintenance

☐ Other (specify): Who will be responsible for immediately notifying the local health department of pressure loss in the distribution system to determine the need to issue a Boil Water Order?

Camps with an on-site potable water system(s) that are not subject to continuous water use must ensure that an acceptable annual start-up procedure is completed. A camp which receives water from an off-site public water system that, due to seasonal use, is not subject to continuous water use, may be required to implement a start-up procedure when the Permit-Issuing Official determines it to be necessary to ensure the satisfactory quality of the potable water. Start-up procedures, including required sampling, must be completed at least 15 days prior to opening for the season. The fact sheet, “Water Supply Start Up Procedures for Children’s Camps” provides guidance on acceptable annual start up procedures and is available from your local health department.

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☒ Camp Director ☐ Head of Maintenance ☐ Other (specify): What will be done if water service is interrupted or unavailable for more than a few hours? Address this issue regardless of the camp's source of water. Check each box that applies:

☐ Notify the local health department

☐ Close camp - Send campers home

☒ Obtain bottled water

☐ Go to an alternate location (specify):

☐ Other (specify): Who will be responsible for the system(s) and maintaining the records of the monitoring? (Contact your local health department for assistance and the forms to maintain proper records.)

☐ N/A (Off-site/Public Water) ☐ Camp Director ☒ Head of Maintenance

☐ Other (specify): Water Samples

☐ Off-site/public water. Skip to question 13. Who will be responsible for collecting water samples?

☐ Camp Director ☒ Head of Maintenance ☐ Other (specify): Sample results that are positive for Total Coliform or Escherichia Coli must be reported to the permit-issuing official as soon as possible but no later than 24 hours of being notified by the laboratory. Pre-operational water analysis reports must be submitted to the permit-issuing official prior to permit issuance. All other water analysis reports requested or ordered by the permit-issuing official shall be submitted to the permit-issuing official within 10 days of the end of each month in which samples were collected.

Sample Type Sample Frequency*

Coliform (Bacterial) Analysis Pre-season (at least 15 days prior to operation) Monthly during the season

Nitrate Once a season

Nitrite New on-site water sources only

*Additional monitoring may be required when determined by the permit-issuing official as necessary. Indicate agreement with the above schedule or state an alternative.

☒ Agreement

☐ Alternate schedule (specify): Sewage Treatment System Does the camp have an on-site sewage treatment system?

☐ No (Skip to question 16) ☒ Yes (Complete questions 14-15)

Untreated sewage effluent may contain organisms that cause serious disease, such as Shigellosis and Hepatitis A. When uncorrected, a sewage discharge may contaminate the camp’s water supply or bathing beach.

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Do any of the camp’s sewage disposal systems require daily treatment and/or monitoring?

☐ Yes – Specify the job title of the person responsible for performing:

☒ No What is the frequency of periodic inspection for system failure or leakage?

☒ Daily ☐ Weekly ☐ Other (specify): Transportation Does the camp provide or obtain transportation services for campers, including to or from camp or camp trips?

☒ Yes (complete questions 17-18) ☐ No (skip to question 19)

Safety Advisory on 15-Passenger Vans: According to the United States Department of Transportation, National Highway Traffic Safety Administration (NHTSA), fifteen-passenger vans are more likely to be involved in a single-vehicle rollover crash than any other type of vehicle. In response, the National Highway Traffic Safety Administration (NHTSA) has issued a safety advisory on these vehicles. Visit NHTSA website (http://www.nhtsa.dot.gov/) for additional information and safety tips if the camp utilizes a 15-passenger van for transporting campers or staff.

What type of vehicles will be used to transport campers? (Check all that apply)

☐ Bus - owned by camp ☐ Chartered Bus ☐ 15 Passenger Van

☒ Other (specify): 3 Mini Vans The following transportation requirements will be implemented: Passengers shall only be transported in portions of vehicles that are designed for passenger occupancy. Transportation in the bed of a truck or trailer shall be prohibited. Every vehicle used for transporting staff or campers shall bear required registration and inspection stickers and be equipped with at least a first-aid kit, tools, fire extinguisher, and flares or reflective triangles that are labeled with the Federal DOT symbol or a statement that the device complies with all Federal Motor Vehicle Safety Standards. The driver of any vehicle transporting campers will be at least 18 years old and possess a valid driver's license. Seat belts shall be utilized by all passengers in vehicles so equipped. Occupancy of a vehicle shall be limited to its rated capacity. Camps serving wheelchair-bound campers will provide an appropriately equipped vehicle for transportation.

☒ Check to indicate agreement with the above procedure. Specify additional or alternative procedures in the space provided below. Housing and Grounds Building and grounds maintenance. Measures taken to maintain the buildings and grounds in a safe and clean matter so as to not present hazards to campers will include but are not limited to: Daily monitoring of building and grounds, including playground equipment and pathways, to ensure they are clean and in good repair.

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The premises will be maintained free of insect and rodent infestations that may cause a nuisance or health hazard. Bats will be excluded from living areas of occupied buildings. If a bat or other animal takes up residence in camp buildings, they will be safely removed, and repairs will be made to keep them out prior to use by campers and/or staff. For information about rabies prevention, including how to safely capture a bat, see the sidebar titled “Rabies Facts” in Section V, Medical Requirements, of this document. Ragweed, poison ivy, poison oak, poison sumac and other noxious weeds will be controlled to minimize contact by camp occupants. Trees along pathways and in areas used by campers will be assessed prior to camp opening, after storms, and throughout the season. Unhealthy trees and broken/damaged limbs will be promptly removed. Garbage/refuse storage and disposal. Provisions will be provided and maintained for the storage, handling and disposal of solid wastes to prevent nuisance conditions, insect and rodent infestations, and pollution of air and water. Hazardous materials. Agricultural, commercial or household pesticides and toxic chemicals will be stored and/or used to cause no air, surface water or ground water pollution and so as not to be hazardous to the occupants of the camp. They shall be stored in their original containers in areas designated for such use. To prevent scalding, water temperatures in lavatories and showers used by campers with physical, intellectual or developmental disabilities, who are unable to moderate temperatures safely, will be maintained to at no greater than 110 degrees Fahrenheit. Other (specify):

☒ Check to indicate agreement with the above procedure. Specify additional or alternative procedures in the space provided below. Reminder: If planning renovations or new construction, contact your local code enforcement officer and health department for specific requirements and necessary approvals early in the planning stages and at least 60 days prior to construction. Notification requirements also apply to water supplies and sewage treatment systems. Food Protection Does the camp provide or prepare food?

☒ Yes (Complete questions 21-23)

☐ No (Skip to Waterfront Physical Facility Maintenance information after question 23)

Kitchens, dining areas and food service must comply with Subpart 14-1 of the State Sanitary Code. Obtain a copy of State Sanitary Code Subpart 14-1 from your local health department or the NYS DOH’s website. Foodborne illness has been identified as the cause of large outbreaks at children's camps. Safe food handling procedures will help protect the camp population from foodborne illness. Information regarding safe food handling, preparation and storage can be found in the department's brochures available from your local health department or at www.health.ny.gov/environmental/indoors /food_safety/guidance.htm. Review the camp's menu. Are there any meals that will require the food to be prepared before the day on which it is served? If so, discuss these menu items with your local health department to determine what safety precautions should be taken.

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Steps taken to prevent foodborne illness will include but are not limited to: At no time shall any ill person be allowed to be involved in food service or preparation. A stem/probe thermometer will be available and used to monitor food temperatures in accordance with Subpart 14-1 for cooking, cooling, reheating, hot holding and cold holding. Gloves or other hand barrier (e.g. tongs, spoon, deli paper) will be used by all kitchen or food service staff to prevent bare hand contact with ready-to-eat foods. When single-service plates and utensils are used (paper plates, plastic utensils) they will be discarded after their use. Tongs, spoons, deli paper or other hand barrier will be used by campers and staff during self-service buffet style lunch lines and on-the table “family style” service to prevent bare hand contact with ready-to-eat foods. Campers and staff will be instructed to wash their hands before serving or eating meals. Staff will monitor camper’s hand washing. Plenty of soap and disposable paper towels will be provided at the hand washing areas. During trips, coolers with ice or ice packs will be used to ensure proper cold holding of 45˚F or less and raw meats will be carried in a separate cooler. Only food from approved sources will be used. Re-service of food previously served to another person will be prohibited. Foods served (e.g. from an individual’s plate or from an on-the-table “family style” portion) will be discarded. The kitchen will be cleaned in a manner and frequency sufficient to maintain a clean and sanitary condition. Other (specify):

☒ Check to indicate agreement with the above procedure with any additional or alternative procedures in the space provided below. Who is responsible for ensuring that the above steps to prevent foodborne illnesses are followed?

☐ Camp Director ☐ Foodservice Manager ☒ Other (specify): Cook/Foodservice Coordinator The camp’s procedures to ensure that food brought by campers or provided by an approved outside source are protected until consumed include (check all that apply):

☒ Refrigeration is provided to hold food at 45˚F or less.

☐ Parent will be notified that refrigeration is not available. Campers’ lunches will be stored in a protected area away from heat and direct sun for consumption at lunch.

☒ A stem or probe thermometer is provided to monitor hot/cold food temperatures at time of arrival, holding and service. Hot foods must be maintained at 140˚F or higher and cold foods at 45˚F or less.

☒ Gloves or similar utensils are provided to prevent bare hand contact with ready-to-eat foods.

☒ Service and storage areas are properly maintained in a sanitary condition.

☒ Leftover food that has been served will be discarded.

☐ Other (specify): Waterfront Physical Facility Maintenance

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Pool, beach, and aquatic spray grounds operated at a children’s camp must comply with Part 6 of the State Sanitary Code. Obtain copies of State Sanitary Codes Subpart 6-1 (pools), Subpart 6-2 (beaches), and Subpart 6-3 (aquatic spray grounds) from your local health department or the NYS DOH’s website. If the camp has a pool or beach, complete the Activity-Specific Plan for Swimming. If the camp has a spray ground, complete the Activity-Specific Plan for Spray Ground Operation.

III. FIRE SAFETY

Evacuation Who will be responsible for coordinating and implementing the evacuation plan?

☒ Camp Director ☐ Program Director ☐ Other (specify): What signal(s) will be used to alert the camp and initiate a fire drill/evacuation sequence? Air horn – 15 blasts – 3 blasts in 5 directions

In case of a fire or other emergency that would require staff and campers to evacuate buildings, an emergency assembly area must be designated. The emergency assembly area should be centrally located, easily accessible and away from buildings, structures or other potential hazards. An open field, such as a ball field, is recommended. It may be necessary to evacuate the camp to an off-premises location during an extreme emergency. At a minimum, a primary route of evacuation should be established. When possible, a secondary route should be designated in the event the primary route is blocked. Once off camp property, an off-site assemblage area must be established. Make necessary arrangements with the off-site property owner prior to the start of camp.

List emergency assemble area(s): Normal: Flag pole; during inclimate weather: dining hall and craft barn; and in an evacuation: The Tyrone Fire Hall Describe or attach a facility sketch identifying the camp evacuation route: Attached

Is there an alternate route if the primary route is blocked? ☒ Yes ☐ No If “yes”, describe below or include on facility sketch: Attached.

☒ Check to indicate evacuation routes are indicated on an attached facility sketch. The first priority is for the evacuation of building(s) and the accounting of all persons. Trained staff should only attempt firefighting when a fire is small and presents no risk to the staff member attempting to extinguish it. No one will be permitted to re-enter a burning building for any reason. Rescue efforts involving a burning building should be conducted by the fire department.

Fire drill/evacuation procedures and method of accounting for and supervising campers and staff during emergencies:

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At the sound of the evacuation alarm campers and staff will proceed to the nearest exit in a quick and orderly manner. Upon exiting the building, staff will take attendance of the campers in their charge and proceed in a quick and orderly manner to the designated assembly area. Upon hearing the fire/evacuation alarm during outdoor activities, counselors will immediately stop the activity, take attendance and proceed to the assembly area. The minimum counselors to camper ratio for general activities will be maintained. Staff will maintain visual and/or verbal communication with campers and ensure that all campers are safe and accounted for. Upon reaching the assembly area each counselor will account for all campers in their charge. Counselors will immediately notify the camp director of any unaccounted for camper and provide information about where the camper was last seen. Attendance to account for all staff and verify that all campers in their charge are accounted for will be taken. Upon identifying a missing person, the lost camper plan will be implemented and the fire department immediately notified.

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided): Fire Drills Drills must run smoothly and rapidly. Fire drills must be conducted within the first 48 hours of each camp session; if campers arrive late, be certain they receive this training. A log with drill dates and times must be maintained on-site and verified by the camp director. It is recommended to conduct drills from various buildings at varying hours with staff prior to the arrival of campers to identify and eliminate potential exiting problems.

Who is responsible for overseeing fire drills?

☐ Camp Director ☐ Head of Maintenance ☒ Other (specify): Support Staff Leader When will fire drills be held? Fire drills shall be held within the first 48 hours of each camping session and (check the frequency below):

☒ Every week thereafter ☐ Every two weeks thereafter

☐ Alternate schedule (specify): During the first fire drill of each session, campers will be instructed on the camp’s evacuation procedures, including building exiting, assembly area(s), and whom to notify if they see a fire. Campers who arrive late to camp or for whatever reason miss the first fire drill of the session will receive training and instructions on fire drill procedures.

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided):

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Fire Prevention Combustibles will be removed prior to the start of camp and throughout the camping season. Items that will be removed include the accumulation of leaves, twigs, garbage, etc., from around and under buildings and excessive storage/accumulation of unused furnishings and supplies in basement and storage areas.

Who will be responsible for the removal of combustibles?

☒ Head of Maintenance ☐ Camp Director ☐ Other (specify): Are containers of gasoline, kerosene and other flammable materials stored on camp property?

☒ Yes ☐ No If “yes”, these items are to be clearly labeled and stored in a separate locked and unoccupied building.

Are oil-based paints and thinners stored on camp property? ☒ ☐ No If “yes”, check all that apply below to indicate what these items are to be stored in:

☐ Approved-type paint lockers ☒ Separate locked and unoccupied building

☐ Other (specify):

Are fuel-fired heaters used in any of the buildings utilized by the camp? ☒ Yes ☐ No If “yes”, who will be responsible for inspecting and maintaining them?

☒ Head of Maintenance ☐ Camp Director ☐ Other (specify): Equipment/heaters requiring inspection (specify): in building heaters are not used during the summer season and are only used for off season retreats, and they are inspected before each use. Inspection and/or maintenance frequency (specify): Before each use in the off season. Coordination with Local Fire Officials

The fire department will be notified of a fire by dialing: ☒ 911 ☐ Other (specify): a. Specify the location(s) of where emergency numbers are posted: Nurse’s Station and Office In the event emergency assistance is called, provide the operator with as much information as possible, including camp address, directions, incident information, and known missing or injured persons. Always let the operator hang up first. Emergency situations can be stressful. Have scripted information such as camp address, driving directions, and where to go when they arrive at camp readily available.

Upon calling the fire department, the camp director will assign a staff member to wait at the entrance of the camp and direct responding emergency personnel where to go.

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

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☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided): The fire department and EMS service should be invited to visit the camp to become familiar with it and insure that their apparatus can negotiate the roads to and within the site prior to each camp season.

Fire Alarm and Detection Systems

Automatic fire alarm systems, when provided, and the related detection equipment must be operated and maintained as to provide adequate warning to all the occupants in the event of a fire. Documentation must be available on-site indicating the system is maintained in accordance with applicable sections of the State Uniform Fire Prevention and Building Code (Uniform Code). Contact the local code enforcement official (CEO) or the NYS Department of State (www.dos.ny.gov/dcea/) for questions regarding Uniform Code standards and compliance.

Complete the table below with the types of fire detection/alarms that are used in camp buildings and the frequency of testing.

Fire Detection/Alarm System Type (Full building alarm system, battery operated smoke detectors, 110-volt single station detectors, etc.)

Building(s) or Location(s) Frequency of Testing

Battery Operated smoke detectors All cabins and sleeping areas. Monthly

Who is responsible for ensuring that detection and alarm systems are tested at the frequency indicated above and maintained in proper working order at all times?

☐ Head of Maintenance ☒ Camp Director ☐ Other (specify):

Automatic fire suppression systems, when provide, must be operated and maintained as to provide detection and suppression functions of fire related events as necessary. Documentation should be available on-site indicating the system is maintained in accordance with applicable sections of the Uniform Code. Portable fire extinguishers must be conspicuously located and readily accessible for use in the event of a fire. Documentation must be available on-site indicating the extinguishers are located and maintained in accordance with applicable sections of the Uniform Code. Contact the local code enforcement official (CEO) or the NYS Department of State for questions regarding Uniform Code standards and compliance.

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Type, Location, and Maintenance of Fire Extinguishers

A variety of classifications of fire extinguishers are available, ranging from Class A through Class K. Class A and Class B extinguishers carry numerical ratings, such as 2-A:5-B, to indicate how large a fire an experienced person can put out with the extinguisher. The larger the number, the larger a fire they can potentially handle; for example, a 10-B extinguisher should extinguish about twice as much fire as a 5-B extinguisher. Extinguishers suitable for more than one class of fire will be identified by multiple letters, such as 4-A:80-B:C. The following is a list of fire extinguisher classes and the types of fire they can most effectively and safely extinguish. Class A – Ordinary combustible, such as wood, cloth, and paper. Class B – Flammable liquids, such as oils, gasoline, and grease. Class C – Electrical equipment, such as wiring, fuse boxes, and energized electrical equipment. Class D – Combustible metals, such as magnesium, titanium, zirconium, sodium, and potassium. Class K – Cooking oils and grease such as animal and vegetable fats.

Complete the table below with the types (standpipe, sprinkler, 4-A:80-B:C fire extinguisher, etc.) and locations (kitchen, infirmary, building 1, etc.) of firefighting equipment provided. One location may have multiple types of firefighting equipment, such as a building equipped with a sprinkler system that also has fire extinguishers.

Equipment Type Locations Equipment Type Locations

Class A Boys bathroom, pump house, cabin 6/7, cabin 0, kitchen, dining hall, gift shop, chapel

Class K Kitchen

All firefighting equipment will be inspected by a qualified individual prior to the start of camp and appropriately tagged. What will be the inspection frequency of firefighting equipment to ensure it is in proper working order?

☐ Daily ☐ Weekly ☒ Other (specify): Before the start of each season. Who is responsible for maintaining and testing the firefighting equipment?

☐ Head of Maintenance ☐ Camp Director ☒ Other (specify): Inspector – Larry Day Inspection and Maintenance of Exits What measures will be taken to inspect and maintain exits?

☒ Doors will not be able to lock against egress by dead bolts, hooks and eyes, etc. All doorknobs will allow single motion opening.

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☒ Where required, lighted exit signs will be in place and in good repair.

☒ Doors swing outward in the direction of egress (except where not required) and unobstructed routes to exits and safe assembly area(s) will be maintained at all times.

☐ Other (specify): Campfire Safety

Does the camp have campfires? ☒ Yes ☐ No (If no, skip to question 45) Campfire procedures will include, but are not limited to: Campfires will only occur in designated fire pits/rings that are away from buildings, tents or other structures, and overhanging branches. The DEC Fire Danger Map (www.dec.ny.gov/lands/68329.html) will be checked prior to making fires to ensure it is safe. All litter, leaves, branches, and other combustible materials will be removed from within a 10-foot diameter around the fire pit/ring. Only clean, dry untreated wood will be used. Painted or treated wood, plastic, glass, metal, or garbage will not be burned. Gasoline, charcoal lighter fluid, kerosene or other flammable liquids will not be used or stored near the campfire. Campfires will be maintained to less than 3 feet in height and 4 feet in diameter. The fire will never be left unattended. Flames or coals, which are not extinguished, can flare up and cause fires. The fire will be completely extinguished by drowning it with water. Make sure all embers, coals, and sticks are wet. Staff will make sure the fire is completely out prior to leaving the area.

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided): Electrical Safety The inspection of the height and condition of overhead electrical wires (including building entry points) and the maintenance of electric outlets, switches and junction and breaker boxes (e.g., keeping covers on the boxes, installing and testing ground fault circuit interrupters near sinks, pools, on outlets for outdoor equipment) are critical components of an electrical safety program.

Who is responsible for the frequency with which inspections are conducted?

☐ Camp Director ☒ Head of Maintenance ☐ Other (specify): How often are inspections conducted?

☐ Daily ☒ Weekly ☐ Other (specify): Reporting

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Who is responsible for reporting to your local health department within 24 hours, fires that destroy or damage any camp building, or that result in notification of the fire department, or are life or health threatening, or necessitate evacuations?

☒ Camp Director ☐ Camp Operator ☐ Other (specify): A copy of the approved Fire Safety section of the camp safety plan must be submitted to the local fire district or department.

☒ Check this box to indicate that the fire safety section of this plan will be submitted to the fire department prior to the start of camp with a letter providing the camp’s operating dates and any special needs.

IV. MEDICAL REQUIREMENTS The camp medical plan must be tailored to the individual camp based on its location, access to emergency care facilities, the medical needs of the campers, and the health director's credentials. Description of Health Center

An overnight camp is required to provide an infirmary with hot and cold running water, examining room, isolation and convalescent space, bathroom with flush toilets and showers, and medical supplies, or have alternate provisions for infirmary services included in the camp safety plan. Summer day camps and children's traveling summer day camps shall provide a holding area satisfactory to the permit-issuing official for all ill or injured children.

What type of health center is provided at the camp?

☐ Holding area ☒ Infirmary ☐ Alternative provisions (describe): Health Director

The camp health director may be a physician, nurse practitioner, physician assistant, registered nurse, licensed practical nurse, emergency medical technician, or other person acceptable to the permit-issuing official. At overnight camps, the health director must be on-site; At day camps, the health director may be on-site or represented on-site by a qualified designee, as described in Section 7-2.8(a) of the State Sanitary Code. At Camps for Children with Developmental Disabilities (20 percent or more campers have a developmental disability), the health director should be a physician, physician's assistant, registered nurse or licensed practical nurse and must be on-site for the period the camp is in operation. The duties and responsibilities of the camp health staff must not exceed the abilities that are allowed by law (known as “scope of practice”). The State Sanitary Code does not grant an individual authority to perform duties that are beyond his/her scope of practice. Camp operators should evaluate the medical needs of the campers and select a health director and other health/medical staff that can fulfill those needs. For additional clarification/questions regarding an individual’s scope of practice limitations, contact the NYS agencies with regulatory oversight of that certification:

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EMTs - contact the NYSDOH Bureau of EMS at (518) 402-0996 or visit their website at www.health.ny.gov/professionals/ems/. Physicians and Nurses - contact the NYS Education Department at (518) 474-3852 or visit their website (www.op.nysed.gov/prof/).

Check the Health Director’s credential(s):

☐ Physician ☐ Physician Assistant ☐ Nurse Practitioner

☒ Registered Nurse ☐ Licensed Practical Nurse

☐ Emergency Medical technician (EMT) ☐ Other (specify): For day camps only – Will the health director be on-site, or off-site and represented by an on-site

designee? ☒ On-site

☐ Off-site (answer question a – b below):

☐ N/A (Overnight Camp) Qualification of the on-site designee include:

☒ Certified in CPR and First Aid

☒ Trained by the health director in the camp’s health procedures and responsibilities

☐ Other (specify): Specify reasons the on-site designee will contact the health director.

☒ Reportable Injuries ☒ Camper Illness ☒ Medication Error

☐ Other (specify): First Aid and CPR Staff

The health director, other staff specified in section 7-2.8 of the State Sanitary Code, and certain camp trip and activity leaders are required to possess valid certification in first aid. See the NYSDOH Fact Sheet titled “First Aid Certification for NYS Children's Camp Staff” for a list of approved first aid courses (www.health.ny.gov/environmental/outdoors/camps/) or contact your local health department. CPR certification is required for the health director and other staff specified in sections 7-2.5, 7-2.8 and 7-2.11(a)(5) of the State Sanitary Code, aquatics director, lifeguards, and certain trip and activity leaders. Annual CPR re-certification is required, regardless of expiration date on card. See the NYSDOH Fact Sheet titled “Cardiopulmonary Resuscitation (CPR) Certification for NYS Children's Camps and NYS Bathing Beaches” for a list of approved courses (www.health.ny.gov/environmental/outdoors/camps/) or contact your local health department.

Specify the camp staff that will possess first aid and CPR certifications:

☒ Health Director ☐ Assistant to the Health Director ☐ Trip Leader

☒ Activity Leader ☒ Lifeguard ☒ Other (specify): Climbing Wall Leader Camper Confidential Medical Histories

The SSC requires a current confidential medical history to be kept on file for every camper and updated annually. Medical history information must include: The child's immunization record, which includes immunization dates against diphtheria, haemophilus influenza type B, hepatitis B, measles, mumps, poliomyelitis, rubella, tetanus and varicella (chicken pox), (Notation that immunizations are “up to date” or similar language is not acceptable.)

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Any restrictions, allergies, medications, special dietary need, and other pre-existing medical, physical, or psychological conditions and illnesses. Physician's name, address and telephone number for campers with disabilities and recommended for all campers. Modified diets and other special needs related to a camper’s disability must be identified for each camper prior to their arrival at camp, reviewed by the camp health director, planned for and provided for in accordance with supplied directions. In addition, camper and staff's family or other responsible person's name, address and telephone to contact during an emergency must be kept on file. No child should be prevented from attending camp because he/she is not immunized! If a child has not received immunizations, a written and signed statement from the parent or guardian stating the reason (due to their religious beliefs, immunosuppression, serologic immunity, medical, etc.), should be included with the child's health history. It is strongly recommended that all staff, including international staff, at camps be fully immunized with all vaccinations recommended by the Centers for Disease Control. Camps should maintain current, complete immunization records for staff. Additionally, camps should maintain a detailed list of staff, campers and other individuals who are not fully immunized and protected against Vaccine Preventable Diseases (VPD). The list should clearly identify which disease(s) an individual is vulnerable to contracting. Camps will need this information to quickly identify at-risk individuals if a suspect case of a VPD occurs. Having immunization and health information readily available allows for a timely and appropriate public health response to control illness when required. If a case of a VPD is identified, suitable precautions must be taken to protect individuals who are not immunized and never had the disease in question. For the NYS Department of Health’s “Recommended Immunization Schedule,” and for further information about immunizations, visit www.health.ny.gov/prevention/immunization/ or contact your Local Health Department or regional New York State Department of Health Immunization Program.

The camp’s health history form (attach a copy of the camp’s health form to this document) will be completed for each camper prior to his or her arrival at camp. The form will be reviewed by the health director and kept on file in the camp’s infirmary.

☒ Check this box to indicate agreement with the above and that the camp’s health form is attached. Items reviewed will include, but are not limited to: Record of immunization history Emergency contact information Recent/current illness/injury/existing medical conditions Restrictions/limitations Special needs/diets Medications/treatments Allergies (e.g. medications, food, insect stings) Other concerns, including bed wetting, sleep walking, etc.

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Any allergies, special diets, activity restriction or other conditions/special needs will be shared with the appropriate staff in charge of the activity (e.g. camper’s counselor, aquatic director, kitchen manager).

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided): Individual Treatment, Care, and Behavioral Plans

Individual treatment, care, or behavioral plans are plans that address an individual’s unique physical, medical, behavioral, and/or social needs. Campers with developmental or other disabilities are not required to have a treatment, care, or behavioral plan to attend a children’s camp. However, when a camper has such a plan, camps are required to obtain them and implement adequate procedures, based on the plan, to protect the camper’s health and safety. Camp operators should consult with the camper’s parents, guardian, and/or clinical team to determine what portions of the plan are relevant to the camp setting. To determine if a camper has a plan, camp operators must inquire with the camper’s parent or guardian. The inquiry should occur as early as possible in the enrollment process, so information about the camper’s disability (developmental and/or physical disabilities) and needs can be obtained and planned for. To accomplish this the State Camp Safety Advisory Council recommends including questions as to any special needs of the camper during the camp’s enrollment process or during other initial contact with parents. It is not advisable to wait for a health form to be submitted. Follow-up, as needed, with parents or guardians should occur as soon as possible to obtain details about the camper’s needs and disabilities.

How will campers with treatment, care, or behavioral plan be identified?

☒ With question on enrolment forms ☐ Other (specify):

Overnight children’s camp operators are required to provide parents/guardians of campers attending camp for seven or more consecutive nights with written information about meningococcal meningitis and with a copy of an immunization response form that has been approved by the State Commissioner of Health. The immunization response form must be submitted annually and kept on file at camp. A sample parent letter and response form, which may be used to comply with the law, are posted on the NYSDOH website at www.health.ny.gov/environmental/outdoors/camps/ or available from your local health department. If a camp chooses to develop and use their own information or forms, the documents must be approved by the NYSDOH Immunization program. Submit documents for review to: New York State Department of Health Immunization Program Room 649, Corning Tower Albany, NY 12237 Fax (518) 474-1495

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Do campers attend the camp for seven or more consecutive nights? ☐ Yes ☒ No If “yes”, who is responsible to ensure that the meningococcal meningitis vaccination response form is received for each camper?

☐ Camp Director ☐ Health Director ☐ Other (specify): Initial Health Screening of Campers An initial health screening for camp participants (staff and campers) will be conducted by the health director shortly after arrival at camp and will include, but not limited to (check all that apply):

☒ A review, verification and update as needed of individual’s health needs/restrictions.

☒ A review/verification of individual’s medications and instructions for use.

☒ Asking the individuals about any potential exposure to communicable disease and recent travel in the two weeks prior to their arrival at camp.

☒ Observing general health and referring to a health care provider when necessary.

☒ Asking individuals to share and discuss any health or other concerns they may have.

☐ Other (specify): Daily Health Surveillance of Campers Daily health surveillance of campers will be conducted that include but are not be limited to symptoms of illness (loss of appetite, nausea, fever, diarrhea, vomiting, rash, etc.) or injury and indications of child abuse (i.e. frequently appearing injuries such as bruises, cuts and/or burns, where the child is unable to provide an adequate explanation of the cause.) Who is responsible for completing camper’s daily health surveillance?

☒ Health Director ☒ Counselors ☐ Camp Director

☐ Other (specify):

For information on recognizing and reporting child abuse and neglect visit www.ocfs.ny.gov/main/cps/signs.asp.

Provisions and procedures for Medical, Nursing and Emergency Medical Services

First aid and CPR staff must be located on-site and readily available to respond to emergency. When an activity is conducted at a location where the camp staff certified in first aid and CPR are not readily available (within five minutes), the activity leader shall possess or be accompanied by staff who possesses a current first aid and CPR certificate. First aid staff and CPR staff must also accompany out-of-camp trips where emergency medical care is not readily available and/or an activity such as wilderness hiking, camping, rock climbing, horseback riding, bicycling, swimming and/or boating.

What are the procedures for providing first aid and handling medical emergencies? In the event of an injury, on-site first aid/CPR-certified staff will be summoned, and will assess the patient. The infirmary will handle injuries that do not require off-site treatment. How will on-site first aid and CPR staff be summoned in the event of an emergency?

☐ Two-way radio ☐ Loud speaker ☒ Runner ☒ Phone

☐ Other (specify):

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For injuries and medical events requiring more than first aid, EMS will be contacted. A staff member will be sent to the entrance of the camp and direct EMS to the location of the victim. First aid and CPR staff will attend to the victim until emergency medical services (EMS) arrive. What are the camp’s procedures for summoning the community emergency medical service (EMS)? 911

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided) Location and Use of First Aid and CPR Supplies Indicate in the table below where available first aid supplies are stored (Check all that apply):

* A Public Access Defibrillation (PAD) program must be established for a camp to maintain an automated external defibrillator (AED). For procedures on how to establish a PAD program, contact your local health department or visit www.health.ny.gov. Please attach a copy of the collaborative agreement with the emergency health care provider for PAD programs.

Does the camp have a PAD program? ☒ No ☐ Yes and the collaborative agreement with an emergency health care provider is attached.

Mental Health First Aid Mental health issues and emergencies encountered at camps present different challenges from other first aid needs. Consideration should be given for staff to receive certification or training that

Supplies Not Available

Infirmary Area

Main Office

Dining Hall

Pool Area

Other (specify):

First Aid Kit ☐ ☒ ☐ ☐ ☒

CPR Mask ☐ ☒ ☐ ☐ ☒

Oxygen ☐ ☐ ☐ ☐ ☐

AED* ☐ ☐ ☐ ☐ ☐

Epinephrine Auto Injector ☐ ☐ ☐ ☐ ☐

Spine Board ☐ ☒ ☐ ☐ ☒ Climbing Wall

Head Immobilization ☐ ☒ ☐ ☐ ☒ Climbing Wall

Other (specify) ☐ ☐ ☐ ☐ ☐

Other (specify) ☐ ☐ ☐ ☐

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prepares non-mental health professionals (teachers, camp counselors, etc.) to recognize when a child is experiencing a mental health issue (anxiety, behavior, mood, or substance use disorder) and intervene in situations where immediate action is needed. Training is not intended to replace professional diagnosis or treatment, but assist adolescents in obtaining the appropriate professional help and intervention.

Preventing Child Abuse

Staff should receive training to help prevent abuse at camp. All allegations of abuse should be taken seriously. Training should include: The identification of indicators of physical and sexual abuse, promoting an understanding of child abuse and its potential effects on victims. Discussion about the camp’s policy regarding appropriate touching, displays of affection and discipline. Review and use roll-play exercises to show appropriate ways to address situations which may occur at camp. Instruction about adequate supervision at the camp. Provide job descriptions outlining supervisory and other responsibilities expected of staff. An explanation of the camp’s procedure to report an allegation of child abuse including the identification of key persons that all suspicions and concerns should be reported to. Other Suggestions: Routinely evaluate staff, including unscheduled staff observations at varied hours of the day and night. Assign new staff to work with experienced staff. Discourage one on one activities/situations between staff and campers. If possible, always pair or “buddy-up” staff with staff, and campers with campers. This is especially important for changing rooms, restrooms, and shower rooms. Encourage respect of privacy of campers and staff. Identify staff that campers should contact if they encounter situations that make them feel uncomfortable.

What are the procedures for responding to allegations of abuse? All staff will be instructed to immediately notify the camp director or health director if they are witness to, or hear of, any camper abuse (physical, sexual or verbal). The accused will be separated from the rest of the camp population. All allegations of abuse will be reported to the local health department and to the appropriate law enforcement agency.

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below:

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided): Storage and Administration of Medicines

Camps are required to establish general polices for medication storage and administration. Some campers may have preexisting conditions that they are accustomed to self-monitoring and controlling on a routine basis, such as diabetes. The camp’s general policies are not intended to address or limit the care or treatment of an individual camper. Individual camper needs should be addressed with the

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camp health director, camper’s parents/guardian, and the camper’s physician to ensure a safe delivery of medication and care while at camp.

Medication collection and storage: All medications should be turned over to camp staff and secured in the infirmary or other area under the control of staff except for emergency medications such as epinephrine auto-injectors and inhalers. For day camps – It is not recommended that campers transport medications each day to and from camp. Parents/guardians should request that the pharmacy provide two containers, one to remain at home and one to remain at camp. With the exception of Epinephrine Auto-injectors and certain immunization agents, prescription medication must be prescribed and dispensed to an individual. Repackaging or re-labeling of prescription medications is prohibited. Prescription medication must be in its original container with labeling that includes but is not limited to: Complete name of patient Date prescription filled Expiration date Directions for use/precautions (if any), and storage (if any) Dispensing pharmacy name & address Name of physician prescribing medication Stock supplies of non-prescription medications (over-the-counter items) may be maintained by the camp or brought to camp by individuals (campers and staff). Individual patient non-prescription medications should be labeled with the complete name of the patient. All campers’ medication (prescription or non-prescription) must be accompanied by a patient-specific written order from a licensed prescriber. Pharmacy labeling on the medication is not sufficient for this purpose as the medication, dosage, and or regimen may have been changed since the pharmacy filled the prescription.

Describe how medication will be collected upon arrival to camp: Upon arrival at camp, campers must provide their medications (prescription and non-prescription) to the camp's health director or designee. For overnight camps – When transportation is provided from a common pick-up point, all medications will be accounted for and collected prior to departure from the location(s). Only prescription medications in a pharmacy labeled container will be accepted. All non-prescription medications will be labeled with the camper’s name. For day camps – The camper’s medications will remain at the camp. Camp staff will review licensed prescriber’s written orders and health histories to ensure required medication have been turned in and properly ordered. When there is an inconsistency between health records and medications brought to camp, the camp will resolve the discrepancy by contacting the parent/guardian. Additional follow-up with the camper’s physician may be necessary as well.

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

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☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided): Describe medication storage: All medications are stored per product directions (e.g. refrigerate, avoid excessive heat) and kept in a secure (locked) area accessible only to the camp health director/designated staff, except when required to be available to the patient for emergency use (e.g. “epi-pen” prescribed for severe allergies, Asthma Inhalers). Those individuals that need emergency medications may carry the medications themselves. When necessary, staff may be assigned to carry the medication; assigned staff will ensure that at all times the patient and medication will remain in close proximity and are not separated. Controlled substances (narcotics) and syringes must be "double-locked" (e.g. locked in a box locked in a cabinet) and standards of best practice followed, including counting the controlled substances upon arrival and periodically thereafter.

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided):

Medication Administration – The children’s camp regulations do not grant a camp or individual authority to perform duties that are beyond his/her certification or license (scope of practice). Medication management must comply with applicable State laws. Camp operators should consult appropriate medical and other professionals when developing their policies and procedures. Some medication schedules can be altered to non-camp times, which will eliminate the camp’s responsibility for oversight. Camp operators can check with the parents/guardians to determine when this is possible. All medication changes must be made by the camper’s physician or other health care provider. In general, when a parent or guardian of a child is not available to administer medications, two options are available: administration by a licensed health care practitioner (e.g. physicians, dentist, nurse practitioners, physician’s assistants, registered professional nurses, and licensed practical nurses) and self-administration. An emergency medical technician (EMT) of any level may practice under their certification only as part of an established emergency medical service (EMS) system. An EMT employed by a children’s camp is not working for an established EMS and therefore cannot routinely administer medications or implement any other EMS protocols. Contact the NYSDOH Bureau of EMS for addition information at (518) 402-0996 or visit their website at www.health.ny.gov/professionals/ems/. First aid staff and staff without medical certification/license are prohibited from routinely administering medication as well.

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Administration by a licensed health care practitioner – NYS Education Law allows a licensed health care practitioner to administer medications (prescription and over-the-counter). A registered nurse (RN) can assess patient health and administer medications including PRN (as needed) medications following orders that are written specifically for an individual camper. A licensed practical nurse (LPN) must work “under the direction” of a NYS licensed physician, other licensed health care provider or registered nurse. A LPN cannot legally assess a patient’s/camper’s condition. A LPN can administer medications following a patient specific order; however, in the case of a PRN (as needed) order, a LPN must first confer with the RN or licensed health care provider he/she is working “under the direction” of. For additional clarification/questions regarding licensed health care practitioner’s scope of practice limitations, contact the NYS Education Department (SED) at (518) 474-3852 or visit their website: www.op.nysed.gov/prof/nurse/. Because of the need to assess a patient’s/camper’s condition, PRN (as needed) medications including over-the-counter medications cannot be routinely administered at camps that do not have a licensed health care practitioner (e.g. physicians, dentist, nurse practitioners, physician’s assistants, RN, and LPN) Patient specific written orders from and signed by a licensed prescriber, describing use of the medication, are required in order for a nurse to administer or to allow a camper to self-administer a medication (prescription and over the counter). A written statement from a camper’s parent or guardian that requests the camp to administer the medication to the camper as ordered by the licensed prescriber is suggested. A written order is not required for campers to carry and use sunscreen under the following conditions: Sunscreen is used to protect against overexposure to the sun; The sunscreen is approved by the FDA for over-the-counter use; and Written permission from a parent or guardian for campers to carry and use sunscreen is obtained by the camp.

How will medication be administered? (select all that apply)

☐ No medication will be administered at the camp

☐ By camper’s parent

☒ Self-administration (complete corresponding section below)

☒ Administration by a licensed health care practitioner (select all that apply)

☐ Physician ☐ Nurse Practitioner ☐ Physician Assistant

☒ Registered Nurse ☐ Licensed Practical Nurse Self-administration procedures – only complete this section if self-administration procedures are used at the camp. Self-administration of medications will only be allowed for those individuals determined to be “independent”. Determination as to whether or not a camper should be considered for self-administration will be made by the health director, camper’s physician or parent and will be based on the camper’s ability to: Identify the correct medication (e.g., color, shape); Identify the purpose of the medication (e.g., to improve attention);

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Determine that the correct dosage is being administered (e.g., one pill); Identify the time the medication is needed (e.g., lunch time, before/after lunch); Describe what will happen if medication is not taken (e.g., unable to pay attention); and Refuse to take medication if camper has any concerns about its appropriateness. In general campers will not be allowed to self-administer “as needed” (PRN) medications, except for emergency medications such as inhalers and epinephrine auto-injectors, or when directed by the camper’s physician and/or parent. Self-administration procedures: The camp health director, or designee trained by the health director in self-administration procedures, will keep a list of all campers in their charge requiring medications, the medication needed, time and dosage to be taken. The camper will be reminded each time when a scheduled dose is to be taken and will read or be read the name of the medication, dosage and other instructions for use. At the time of self-administration, the health director or designee will verify who the camper is and that he or she has the correct medication, dosage and other use instructions. Medications will be handed, in the original container, to the camper for self-administration. Camp staff that are not licensed health care practitioners may not pour or dispense pills into container(s) for ingestion. Staff that remove medication from the original container are administering medication. Staff may help camper loosen container cap, if necessary. Administration of the medication will be witnessed and documented by noting (in the medical log or recipient’s health record) the names of the recipient, medication, dosage, witness, and the date, and time self-administered. Medication will be returned and properly stored.

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided): Medication administration including the camper’s name, medication, dosage, and date will be documented in the following location.

☒ Medical log ☐ Camper’s medical record ☐ Other (specify):

Medication Errors – A carefully designed and executed medication delivery system is the best deterrent to prevent medication errors. A medication error includes any failure to administer medication as prescribed. This includes failure to administer the prescribed medication to the correct camper, at the correct time, in the correct dose or through the correct route. Medication errors can occur when an individual is interrupted or distracted. Eliminating distractions and/or other responsibilities during periods of concentrated medication administration can increase safety and decrease the potential for errors. Medication errors must be addressed immediately.

What actions will be taken in the event of a medication error? If adverse reaction, call 911 and/or contact the Poison Control Center (if wrong medication or overdose given).

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Notify the health director or other supervising medical staff, if not present. Notify the camper’s parent or guardian. Notify the camper’s physician and/or the licensed prescriber. Document medication error detailing camper's name, specific details of the medication error, reaction to medication given, which individuals were notified, and remedial action. Review the medication errors and take necessary steps for appropriate medication administration in the future.

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided): Injury and Illness Prevention and Control

Injuries are not “accidents”; they are predictable and preventable events that can be controlled when appropriate interventions occur. Establish an injury control program at the camp. Routinely review injuries noted in the medical log. Have injuries occurred at one activity, location or under the supervision of one counselor in particular or are there other common threads between injuries? If so monitor the event in question for obvious contributing factors. You may need to interview the victims/witnesses for more information about the injury event and pre-event also. There are preventative measures that can be taken! Example: Over a two-week period, two 6-year-old campers playing on the playground sustained cuts on their hands, which required sutures. Your questions to the counselors and victims lead you to a swing, which at first glance appears safe. You ask the victims to show you what they were doing, and learn both were sharing the swing with another camper. With two campers in the swing, you note the additional weight causes a sharp piece of wire to protrude below the seat! Preventative Measures: Maintenance staff replaced the damaged swing seat and checked all the others for similar defects. Playground staff modified their written plan to include the routine inspection of the swing seats, and to allow only one camper per swing. The health director reviewed medical log entry requirements with her staff, and reminded them to provide details about how and where incidents occur.

Who is responsible for the camps injury control program?

☒ Camp Director ☒ Health Director ☐ Other (specify):

The spread of gastrointestinal (vomiting and diarrhea), respiratory and other ailments can quickly change a pleasant camp visit into a difficult experience for staff and campers. Early identification and intervention may prevent additional cases of illness.

What are the procedures for identifying and responding to an illness outbreak?

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The health director or designee will check the medical log entries daily for common ailments and/or increased frequency of cases of illness with similar symptoms (e.g. headache, vomiting, diarrhea, fever, eye infection, sore throat). If noted: The local health department will be contacted immediately. Intervention and control strategies recommended by the local health department and medical staff will be implemented at the camp to prevent the spread and reoccurrence of illness. General intervention and control strategies to be implemented for an outbreak include but are not limited to: Ill persons will be excluded from duties (e.g. food preparation/handling) and/or activities until permission is granted by the health director to resume. Ill individuals will be physically separate from well; housing areas for large number of ill at overnight camps will be designated, and ill day-campers will be sent home. Entry/exit from camp will be limited; activities involving visitors, including other camps will be postponed or restricted. Hand washing (staff and campers) will occur frequently and not just during outbreaks! Campers and staff will be instructed to wash hands after activities, and always after using the bathroom and before eating. Staff will monitor camper’s hand washing. Plenty of soap and disposable paper towels will be provided in hand washing areas. Housekeeping – “Sick” areas (bathrooms, sleeping areas etc.) will require increased housekeeping emphasis. Housekeeping staff will be instructed to wear gloves and follow other precautions, as directed. Staff will be instructed to practice thorough hand washing, and will be encouraged to change to clean clothing prior to resuming other activities. Discontinuing salad and sandwich bars, "family-style" service, buffets - use servers only.

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided):

Diseases transmitted by insects and ticks: Protective measures should be used in areas where Lyme disease and other diseases transmitted by ticks and insects are present. This includes but is not limited to wearing clothing to cover legs and arms, eliminating standing water where mosquitoes breed, keeping outdoor play areas well maintained, avoiding areas of tall grass and brush, checking oneself for ticks, and considering the use of repellents. Ticks that spread disease, including Lyme disease, may be found in outdoor areas where camp activities take place. Ticks will cling to tall grass, brush and shrubs, usually no more than 18-24 inches off the ground. They also live in lawns and gardens, especially at the edges of woods and around old stone walls. If camp activities occur in areas known or suspected of having ticks, provide parents with information regarding the prevention and signs of Lyme disease. New York State Public Health Law allows campers to carry and use tick and insect repellents when the child’s parent or guardian provides written permission for it. Camp staff may assist campers with the

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application of the repellent when the child is unable to do so, provided the child requests the assistance and it is permitted/authorized by the parent/guardian and the camp. Camp operators must maintain a record of the parental/guardian permission. It is recommended that the camp health form include authorization for the use of specific tick and/or insect repellent and need for assistance. Staff should receive training in the proper use of tick and insect repellents including: Read instructions and follow directions on the label, do not over apply, and determine whether product can be used on skin, or if it can only be applied to clothing and gear. Discontinue use and seek medical attention if a rash or other reaction occurs. Only use repellents approved by camper’s parent/guardian. If an embedded tick is found on a camper he/she should be immediately taken to the infirmary and parents should be notified. Information including tick removal, Lyme disease, and safe use of tick and insect repellents can be found at: www.health.ny.gov/diseases/communicable/lyme/ www.cdc.gov/ticks/

Will campers carry and use repellents during activities where ticks and insects may be present?

☒ Yes ☐ No If yes, who is responsible for obtaining written parental permission?

☐ Camp Director ☒ Health Director ☐ Other (specify):

Potential Rabies Exposure: Rabies is a deadly disease caused by a virus that attacks the central nervous system of mammals, including humans, pets, livestock and wildlife. Animals testing positive for rabies have been found throughout NYS. All animal bites and scratches, and any contact whatsoever with bats or animals suspected of having rabies, must be reported to the camp’s permit-issuing official IMMEDIATELY to determine if testing of the animal or human post exposure treatment is required. For additional information on this subject visit www.health.ny.gov/environmental/outdoors/camps/ or contact your local health department. Pre-camp: Repair or modify camp buildings to keep bats and other animals out. Make sure that doors and windows are secure, and any small openings that might allow an animal entrance are sealed or screened, including chimneys, vents, etc. Don’t occupy buildings until they are animal-proof, and free of unwanted animals. Provide animal-proof garbage containers and arrange for routine refuse removal, and cleanup and monitoring of these areas. If pets or domestic animals are allowed at the camp, be certain these animals are immunized against rabies. Proof of current immunization should be maintained on file at the camp for the animals at camp. Potential Exposure – If a bite, scratch or other contact with a suspect animal occurs:

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IMMEDIATELY wash the victim’s wound(s) or exposed site thoroughly with soap and water. Seek medical assistance. If possible to do safely, try to confine or capture the suspect animal, or seek assistance as noted above. IMMEDIATELY notify your local health department to report the incident and exposure details (circumstances leading to incident, who was involved or present, location, if the animal was captured, etc.) and to arrange for testing the suspect animal (if available). If the animal is found dead, dies or is killed, refrigerate the carcass with ice until testing is arranged. Potential Exposure – BATS – If ANY exposure to a bat occurs, or if a bat is found in a room where someone was sleeping, or someone was present who could not communicate (e.g. infant, young child, person with sensory or mental impairment): Notify your local health department and describe the circumstances. Try to confine or capture the bat (without causing damage to the head) for testing. See video at www.health.ny.gov/diseases/communicable/zoonoses/rabies/. To aid in the capturing bats, camps should prepare by having a bat capture kit consisting of: Gloves (heavy, preferably pliable thick leather) Forceps (9" to 12" length, rat-tooth for gripping) Extension pole w/net (fine mesh insect net of polyester or muslin material with a spring steel hoop on telescoping pole – net and pole sold separately) Coffee can w/tight-fitting lid or similar container (e.g., cardboard ice cream carton w/lid; keep multiple containers on hand) Sheet of cardboard to slide between wall and container to act as a lid Tape (to secure lid on container) Flashlights (including fresh batteries & extra batteries) General Guidelines for Management of Bat-Related Incidents at Children's Camps Training - Information must be provided to staff and campers during training to prevent potential rabies exposure and, where possible, avoid the lengthy and costly rabies post exposure treatment: Never feed, rescue, handle or intentionally get close to any wild animals, including bats in caves and “abandoned wildlife.” Don’t touch and avoid injured, ill or stray animals. Don’t touch and avoid pets and domestic animals you're not familiar with. Don’t touch and avoid any animal that exhibits behavior that appears abnormal. Report to appropriate camp staff (e.g. camp director, health director) IMMEDIATELY: The presence and location of any suspicious animal. The presence of a bat in any sleeping area or in a building used for activities or assembly, or a dead or grounded bat, or a bat roosting within reach (indoors or outdoors) of campers or staff. Any injury caused by contact with an animal.

Who will be responsible for capturing a bat or contacting a nuisance wildlife agent if a suspect animal is found at the camp?

☐ Camp Director ☐ Health Director ☒ Maintenance staff

☐ Other (specify):

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Are bat capture kits maintained at the camp? ☒ Yes ☐ No If “yes”, where are they maintained?

☐ Each bunk ☐ Bunk number(s) ☒ Maintenance area

☐ Other (specify):

Diabetes Prevention and Control: The DOH Bureau of Chronic Disease Services, Diabetes Prevention and Control Program has developed a publication titled, Children with Diabetes: A Resource Guide for Families and Schools. The resource guide provides valuable information and tools that may be utilized by camps for the prevention and management of diabetes in children. The resource guide is available to download from the DOH website at www.health.ny.gov/publications/0944.pdf or hard copies may be ordered from the DOH forms distribution center.

Medical Log The health director or designee will document all health-related incidents involving campers and staff, including medical complaints and injuries, and camper allegations of child and/or sexual abuse in a logbook. The medical log will be maintained at the health center and readily accessible for review by the health department representative. The health director or designee will review the medical log daily for any commonly occurring injuries or illness to identify potential hazards or illness outbreaks at the camp. At a minimum, the medical log will include the following information: Date and time of visit Name of patient Camper, staff (title) or other (indicate) Name of bunk or group, if applicable Nature of complaint Description of treatment and follow-up, if required Name of care giver

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided): Universal Precautions

Universal Precautions is an approach to infection control. Accordingly, all human blood and any other human body fluids should be treated as if known to be infectious for HIV, Hepatitis Virus and other blood-borne pathogens.

Universal Precautions will be employed during treatment and in the handling of blood and other body fluids including, but not be limited to, vomitus, diarrhea and any bodily discharge (e.g. from cuts, boils). Universal Precautions implemented at the camp include (check all that apply):

☒ Every first aid trained staff member will be trained in Universal Precaution techniques.

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☒ All bodily fluids shall be considered potentially infectious material. Protective barriers, such as gloves and masks, will be used to prevent contact with bodily fluids.

☒ Any surface or equipment that has been contaminated by blood or any other bodily fluid shall be cleaned and sanitized with a bleach solution of 1 part bleach to 10 parts warm water.

☒ Hand washing facilities, which are readily accessible, are available throughout the camp.

☒ Any contaminated bandages, dressing or any other material will be separated from other wastes and disposed of in a red biohazard bag. Containers used for the contaminated waste will be marked prominently on the containers with the universal warning sign or the word “biohazard.”

☒ Any needles will be placed in an approved “Sharps” container labeled “biohazard” and taken to an approved collection location. (Most hospitals will accept “Sharps” waste for disposal and some Fire Departments can assist in “Sharps” disposal. In addition, you can check with the local sanitation district to see if they offer “Sharps” disposal sites).

☒ When away from camp (off-site-trips), an antiseptic hand cleanser or towelettes will be provided. As soon as possible, hands will be washed with soap and running water.

☐ Other (specify): Reporting of Incidents

The local health department must be notified, within 24 hours, of the following occurrences: Camper and staff injuries or illnesses that result in death or require resuscitation, admission to a hospital or the administration of epinephrine. Camper or staff exposures to animals potentially infected with rabies. Camper injuries to the eye, head, neck or spine which require referral to a hospital or other facility for medical treatment. Injuries where the camper sustains second or third degree burns to 5 percent or more of the body. Camper injuries that involve bone fractures or dislocations. Lacerations sustained by a camper that require sutures, staples or medical glue. Camper physical or sexual abuse allegations. Camper and staff illnesses suspected of being water-, food- or air-borne or spread by contact. At Camps for Children with Developmental Disabilities (20% or more enrolment of campers with developmental disabilities) staff must also report all allegations of abuse or neglect and significant incidents to the local health department and the Justice Center and possible crimes against campers with disabilities to local law enforcement and the local health department. See the Requirements for Camps for Children with Developmental Disabilities for additional details.

Who will be responsible for establishing reporting policies for the incidents above?

☐ Camp Director ☒ Health director ☐ Other (specify): Provisions to Supervise Sanitation

Camp Sanitation is important to prevent disease transmission. Camps must establish a procedure to oversee sanitation at the camp.

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Specify the camp’s procedures for supervising sanitation at the camp: The health director or designee will oversee the camp’s general sanitation assessment as well as conducting on-going sanitation reviews. This will include but not be limited to visiting the area of camp indicated below at the indicated frequency to assess cleanliness and sanitation: Area Frequency of Visit

Kitchen and dining area ☒ Daily ☐ Weekly ☐ Other

Refuse management and disposal ☐ Daily ☒ Weekly ☐ Other

Living quarters ☒ Daily ☐ Weekly ☐ Other

Sewage system ☐ Daily ☒ Weekly ☐ Other

Water supply ☐ Daily ☒ Weekly ☐ Other

Pool/Beach ☒ Daily ☐ Weekly ☐ Other

Other buildings/bathrooms ☒ Daily ☐ Weekly ☐ Other

V. SUPERVISION AND ACTIVITY SAFETY

Camper Supervision

Supervision of the campers is the single most important aspect of a children's camp. It is recommended staff always be assigned to supervise specific campers. Many camps “buddy” staff, so coverage is available in case of an emergency. The State Sanitary Code (SSC) requires that campers receive “adequate supervision,” which is defined as: Being protected from any unreasonable risk to their health and safety, including physical or sexual abuse; and Having visual or verbal communication capabilities between campers and their counselor during activities and a method of accounting for the campers’ whereabouts at all times. The minimum required counselor to camper ratio varies based on the type of camp (day vs. overnight), age of the campers, the activity and individual camper’s needs: At overnight camps, the minimum counselor to camper ratios for general activities is: 1:10 for campers 8-years and older 1:8 for campers younger than 8-years-old At day camps, the minimum staff to camper ratios for general activities is: 1:12 for all campers The minimum ratio of counselors to campers who are confined to wheelchairs or require the use of adaptive equipment or bracing to achieve ambulation, but who do not possess, for whatever reason, the ability to fit, secure or independently manipulate such devices satisfactorily to achieve ambulation, is 1:2. Additional staff may be necessary to ensure the safety of campers based on the type and location of an activity and needs of each camper.

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How will campers be accounted for and supervised? At the beginning of each session, counselors will be given a list of campers under their charge for that camp session or activity. Counselors will take attendance frequently, including at the beginning of each day and activity, to account for all campers in their charge. If a camper is unaccounted for, the counselors will immediately notify the camp director. At all times the counselors will provide a level of supervision that shall protect campers from any unreasonable risk to their health or safety, including physical or sexual abuse. Counselors will actively supervise campers, maintaining visual or verbal communications capabilities at all times to ensure camper activities are safe and consistent with safety plan and camp policies. Counselors supervising campers with developmental or physical disabilities will be trained in the specific needs and special considerations for the campers.

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided): What minimum counselor to camper ratio will be maintained for general activities (e.g. arts and crafts, sports, organized games):

☒ 1:8 for campers younger than 8-years-old ☒ 1:10 for campers 8-years and older

☐ 1:12 (day camps) ☐ Other (specify)

State Sanitary Code allows for a Counselor-in-training (CIT) or Junior Counselor, who is a camper, to be assigned to an on-duty counselor or other staff member to assist in performing specific duties. A CIT may not independently supervise campers, and must be supervised as a camper. All CITs must receive training specific to their duties, and camper orientation. A maximum of 10 percent of the total number of counselors required may be CITs. See Subpart 7-2.5(k).

Will CITs or Junior Counselors be used to meet minimum supervision ratios?

☐ Yes ☒ No How will campers be supervised during the following the following time periods? Between scheduled activity periods (traveling from one activity to the next):

☒ Camper supervision will be in accordance with the standards listed above in numbers 75–77 including ratios, accountability and counselor to camper communication capabilities.

☐ Campers may travel between activities/areas without direct staff supervision. When this occurs, the staff member in charge of the activity/area the camper is traveling to will have a list of all expected campers, where they are coming from and the time that activity ends. A maximum of five minutes will be allowed for travel to the activity/area. If the camper does not arrive at the expected location within five minutes of the end of the previous activity the staff member in charge will immediately notify the Camp Director and initiate the lost camper plan.

☐ Alternative procedures to account for campers between activities:

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Passive activities – an activity that takes place in a defined area, where participants are spectators or have limited mobility and use no tools or equipment (other than computers).

☐ Camper supervision will be in accordance with the standards listed above in numbers 75 – 77 including ratios, accountability and counselor to camper communication capabilities.

☒ A counselor to camper ratio of 1:25. (Select all passive activities at the camp)

☒ Religious instruction ☒ Storytelling ☒ Viewing movies

☐ Board games ☒ Drama ☒ Singing

☐ Other (specify):

☐ Alternative procedures for supervising campers: Free Time:

☐ No free time periods during camp.

☒ Camper supervision will be in accordance with the standards listed above in numbers 75 – 77 including ratios, accountability and counselor to camper communication capabilities.

☐ Alternative procedures for supervising campers: Sleeping and rest hours

During the hours campers are resting or sleeping, the supervision ratio may be modified based on the arrangement, size, and location of the sleeping area(s) and potential for visual and/or verbal supervision; provided in all circumstances that: Supervision is adequate to protect the campers from any unreasonable risk to their health or safety; and At least one counselor is present on every level used for resting or sleeping in a multi-story building. Staffing levels must be adequate to respond to emergencies at all times. Supervision ratios must be reinstated to the code-required level at the conclusion of the resting or sleeping period.

☐ No sleeping or rest periods during camp (day camps only).

☒ Camper supervision will be in accordance with the standards listed above in numbers 75 – 77 including ratios, accountability and counselor to camper communication capabilities.

☐ Alternative procedures for supervising campers. Applicable time periods: Minimum staff to camper ratio: Describe ability to provide visual and/or verbal communication with campers. Include or attach a sketch of staff positioning relative to campers (indicate the arrangement, number of floors, and camper capacity for each building). Transportation:

☐ Transportation is not provided by the camp

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☒ Camper supervision will be in accordance with the standards listed above in numbers 75 – 77 including ratios, accountability and counselor to camper communication capabilities.

☐ At least one counselor will be in a vehicle transporting campers.

☐ There will be at least one counselor in addition to the driver in any vehicle transporting developmentally disabled campers.

☐ Alternative procedures for supervising campers: Describe the camp’s discipline policy. Discipline will be aimed at addressing and correcting unacceptable behavior. Counselors who are unable to quickly, safely and effectively deal with a camper who is misbehaving will utilize the chain of command to address the situation. Forms of acceptable discipline may include: talking to the camper about their behavior, discussion of the expectations the camp has of all campers, asking the camper to express his feelings, mediation of a dispute, and notification of parents/guardians. Discipline that is considered unacceptable and that will not be allowed includes but is not limited to corporal punishment, humiliating treatment, frightening methods, punishment associated with food, rest or isolation, and use of foul or abusive language.

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided): What is the camp’s lost camper plan? In the event that a camper becomes lost or unaccounted for, the Lost Camper Plan will immediately be activated, which will include the following: Provide and maintain adequate supervision for all remaining campers Notify the Camp Director and other counselors of the identity of the missing camper Interview staff and campers in an attempt to determine the last known whereabouts of the missing camper. Begin a search, starting with the last known place of the camper and nearby restrooms, and high risk areas (e.g. pool, beach). If out of camp, the assistance of the facility being visited will be requested. Camp staff will be sent the designated meeting area and the exits of the facility. Maintain the supervision of campers and widen the search area. The police will be notified if the camper remains unaccounted for greater than:

☐ 10 minutes ☐ 20 minutes ☒ 30 minutes

☐ Other (specify) Parents/guardians will be notified. Contact the local health department within 24 hours if the camper has not been located or if a reportable injury has occurred.

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided):

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Activity Safety

Each camp activity must be evaluated to establish appropriate policies and procedures for the supervision and prevention of injuries to camper. Additional staff are required for specialized activities such as wilderness, equestrian, boating, etc. 1:8 for campers 6-years and older 1:6 for campers less than 6-years-old On-site activities – An activity leader must supervise each camp activity occurring on the camp’s property and be competent in the activity being conducted. A minimum of one activity leader and one staff member must supervise activities that occur at locations where additional camp staff assistance is not readily available (within five minutes). When a camp activity is conducted at a location where the camp staff certified in first aid and CPR are not readily available, the activity leader must possess or be accompanied by staff who possesses current first aid and CPR certification in an approved course. NYSDOH Fact Sheets listing approved CPR and First aid certifications are available at www.health.ny.gov/environmental/outdoors/camps or by contacting your local health department. The activity leader for activities that includes wilderness hiking, camping, rock climbing, horseback riding, bicycling, swimming and/or boating must be at least 18 years old. Camps with developmentally or physically disabled campers - all appropriate recreational activities must be accessible by providing ramps, proper surfaces for movement, and/or adaptive equipment.

Check all activities available to campers in sections a and b and complete the specified Activity-Specific Plan or Generic Activity Plan Template for that activity. Complete the Activity-Specific Plan template (available from your local health department) for each of the following activities available to campers:

☒ Archery ☒ Swimming

☒ Boating/Canoeing/Kayaking ☒ On-Site

☒ Camp Trips ☐ Off-Site (complete Camp Trip Swimming Plan)

☐ Horseback Riding ☐ Wilderness (complete Camp Trip Swimming Plan)

☐ Riflery

☒ Sports

☐ Aquatic Theme Parks (complete Camp Trip Swimming Plan)

☒ Ropes/Challenge Course

Complete the Generic Activity Plan template (available from your local health department) for the following activities available to campers:

☐ Aquatic Theme Parks ☐ Ice Skating ☒ Tubing

☒ Arts and Crafts ☐ Mountain Boarding ☐ Whittling/woodcarving

☐ Bicycling ☐ Nature Study ☒ Other (specify):

☐ Cooking ☒ Organized Games (Play) Hay Rides

☐ Gymnastics ☐ Petting Zoo

☐ Go Carts ☐ Roller Skating/Blading

☒ Hiking ☐ Skate Boarding

Weather Conditions Estimates made by sources such as the National Weather Service indicate that approximately 400 people are struck and seriously injured by lightning each year. One out of four victims is killed. To minimize risk for injury from lightning, camp staff must monitor local forecasts for thunderstorms

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and restrict activities to locations that provide adequate shelter. For additional information regarding lightning safety, the Department’s Fact Sheet titled “Lightning Safety Basics” is available at www.health.ny.gov/environmental/outdoors/camps/.

Heat-related illnesses occur when the body is unable to cool itself. The most common heat-related illnesses are heat stroke (sunstroke), heat exhaustion, heat cramps and heat rash. The risk of heat related illness increases with the air temperature and relative humidity. Based on the relation of the two, the National Weather Service has devised a heat index to alert the public of days that have a potential for causing illness. In general, a heat index of 90 or above may result in heat illness. For additional information see the Department’s brochure titled “Keep Your Cool During Summer Heat”. The key in preventing heat related illness is to be aware of the weather conditions that have potential for adverse effects and to schedule less strenuous activities during those times. Additionally, drink plenty of cool water or other fluids prior to and during activities.

Who monitors and assesses weather conditions to cancel or curtail activities (on-site and during camp trips) due to weather, such as thunderstorms, high heat and/or humidity and elevated ozone levels, and notifies activity staff leaders of activity restrictions?

☒ Camp Director ☐ Program Director ☐ Other (specify): Means of staff notification will include but not be limited to:

☒ Direct verbal contact ☒ Cell phone ☐ Portable radios

☐ Public address systems ☐ Other (specify): Which activities will be suspended or minimized in anticipation and response to thunderstorm and lightning activity? (check all that apply)

☒ Hikes and other activities that would prevent staff and campers from access to immediate cover in a shelter, car or bus.

☒ Swimming (outdoors and indoors), boating or other activities in or on the water.

☒ All outdoor activity will be ceased if thunderstorm and lightning activity occurs.

☐ Other (specify):

A substantial building that has plumbing or electrical service, is completely enclosed and has sufficient capacity to shelter all campers should be used as a shelter against storms. In addition, on high-risk days or during high-risk periods, the camp may modify their daily program and replace outdoor activity with indoor activity in a primary structure either on the camp property or off-site such as a movie theater, bowling alley, etc.

Specify the locations/buildings designated as shelters for storms: Dining Hall Craft Barn/Noah’s Ark

What instructions will be provided for those caught away from shelter/camp by a storm?

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☒ Cease all outdoor activity and seek shelter inside the nearest large building that is deemed acceptable. If no building is available, a car or bus will be utilized.

☐ Do not use telephone except in an emergency (cell phones or cordless phones are acceptable for use).

☒ If no shelter of any type is available, then:

☒ Stay away from utility poles and tall, isolated or lone trees.

☒ Stay off of or leave hill tops.

☒ Avoid wire fences, pipes, and metal poles.

☒ If unable to get to a substantial shelter, assume a protective crouch position with your legs bent at the knees and your feet close together; keep your hands on your knees and lower your head toward your knees (do not lie down).

☒ If in a group, stay several yards apart.

☐ Other (specify) Camp will not resume outdoor activities until thunder has not been heard for at least a full thirty

minutes. ☒ Yes

Sun protection – skin cancer is the most commonly diagnosed cancer in the United States. The biggest risk for skin cancer is unprotected exposure to the sun during childhood. Some simple steps that can be taken at your camp to protect against sun exposures include: Limiting the amount of time spent in the sun, especially between 10 am and 4 pm. Conduct activities in shaded areas whenever possible. Wearing protective clothing such as a wide-brimmed hat, long-sleeved shirt, long shorts or pants, and sunglasses that state that they protect from 100% of UVA and UVB. Using sunscreen labeled "broad-spectrum" with a sun protection factor (SPF) rating of 15 or higher. For additional information visit www.health.ny.gov/diseases/cancer/skin/ or contact the NYSDOH Bureau of Chronic Disease Control at (518) 474-1222.

Incidental Water Immersion

Incidental water immersion is the intentional entry into a body of water for a purpose, other than swimming, which is ancillary to the primary activity being conducted. Such immersion, including partial immersion, shall include but not be limited to stream crossing or entering water for personal hygiene, but shall exclude boating, water skiing, sail boarding and similar water sports where participants wear U.S. Coast Guard approved lifejackets.

Does incidental water immersion occur during any camp activities (on-site or off-site)?

☐ Yes ☒ No If “yes”, complete the following section. List below the activities (on-site or off-site) during which incidental immersion is permitted: 1) What are the procedures for incidental water immersion? Incidental water immersion will be prohibited when the water’s depth cannot be determined or when the water’s depth or current does not ensure a safe crossing. Water Depth: (Select one)

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☐ Incidental water immersion is not permitted in water deeper than mid-calf of the shortest camper.

☐ The following procedures(s) will be used for incidental water immersion in water deeper than mid-calf of the shortest camper (specify below) Staff will test the entire area in which incidental immersion will occur prior to campers entering the water. A trip or activity leader must be familiar with safe water flow characteristics and camp safety plan procedures for any body of water entered.

☐ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided):

VI. ORIENTATION AND TRAINING

While the two processes (staff training and camper orientation) are similar, they differ considerably in the depth to which various topics are covered, as can be seen from the examples below.

Topic Staff Training Camper Orientation

Child Abuse

Need to be trained to know, understand, and recognize what abuse is. Must know when and to whom to report all allegations/observations regardless of the source.

Only need to know that if they are uncomfortable about anything at camp, to whom they should go to discuss it. There should always be one route through their counselor/unit leader and another independent route, such as through the health director.

Buddy System and Waterfront Supervision

Need to know how to scan water and their supervision responsibilities at the waterfront. Need to know how to help run a buddy check. Need to know their role in lost swimmer plan. Need to know and enforce rules (e.g. diving, running, etc.)

Need to know to stay with their buddy and how to answer a buddy check. Need to know what to do if their buddy leaves the water or disappears.

Camp directors for camps with camper enrollments of 20 percent or more developmentally disabled campers must develop a written staff training program appropriate to the specific needs of the developmentally disabled enrolled in the camp.

Staff Training

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Staff training and orientation is as important as the selection of good staff. Training programs should occur prior to the arrival of the first campers. Provide an estimated time spent during staff training for each of the following subject areas:

Subject Estimated time (hours/minutes)

An outline of the training curriculum 1 hour

Tour of camp property 1 hour

Description of camp hazards and policies for eliminating or minimizing them 30 minutes

Chain of command 30 minutes

Procedures for camper supervision and discipline 30 minutes

Child abuse recognition and reporting 1 hour

Provisions for first aid and emergency medical assistance 1 hour

Reporting of camper injury and illness 30 minutes

Identification and reporting of crimes against campers with disabilities (Required for Camps for Children with Developmental Disabilities only)

Buddy system and lost swimmer plan (if camp has an aquatics program) 30 minutes

Lost camper plan 30 minutes

Lightning plan 30 minutes

Fire safety and fire drills 30 minutes

Camp evacuation procedures 30 minutes

Activity specific training for assigned activities 4 hours

Camp trips (if provided) 1 hour

Other (specify)

Other (specify)

Other (specify)

What are the procedures for conducting staff training?

☒ Prior to any counselor starting work at the camp, they will attend staff training minimally consisting of the topic list above and based on the contents of this safety plan. A “sign-in-sheet” will be provided at all staff training to document the attending staff members, date of training, and content of what was covered during the training. Sign-in-sheets will be maintained at the camp for inspection by the local health department.

☒ Prior to assuming direct care responsibilities of a camper with disabilities, camp staff will receive training in the specific needs of the camper in their charge. Training provided will be based on information provided by the camper’s parent, guardian, and/or clinical team. The training/instruction will be documented including the name of the person receiving training, the date of training, the name of the trainer, and topics discussed.

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☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided): Camper Orientation Every camper must receive, on arrival at the camp, an orientation to the camp and the camp’s policies and procedures. Provide an estimated time spent during camper orientation for each of the following subject areas:

Subject Estimated time (hours/minutes)

Orientation curriculum outline 5 minutes

Tour of camp property 30 minutes

Description of camp hazards 10 minutes

Chain of Command 5 minutes

Reporting illness, injury, abuse and other incidents 5 minutes

Buddy system 5 minutes

Lost camper plan 10 minutes

Lightning plan 10 minutes

Fire drills and evacuation 10 minutes

Camp trips 30 minutes

Other (specify)

Other (specify)

How will camper orientation be documented?

☐ Camper sign-in sheet

☒ Camp Director documentation of participating campers and date of orientation

☐ Other (specify)

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Campus Map

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EVACUATION PLAN

* The Assistant Administrator or Maintenance Coordinator is responsible for coordinating and implementing the evacuation plan. Evacuation Plan:

1. The Camp Administrator or designee will sound the emergency signal - 3 blasts in 5 directions. 2. While the alarm is sounded, the Camp Administrator or designee will call the fire department –

911. 3. In response to the emergency alarm, all campers and staff will evacuate every building and

assemble promptly at the flagpole – or in inclement weather the girls will go to the Dining Hall and the boys to the Craft Barn to take roll call.

4. Counselors and staff will serve as fire marshals, assisting in the orderly evacuation of the buildings for which they are responsible – responsibilities will be assigned during the summer’s C.I.T. week.

5. If a camper is missing at roll call, the Fire Department will be notified and the Lost Camper Procedure implemented.

6. No one will go near the fire without permission from the Administrator. 7. Adult staff members will be responsible for extinguishing fires if:

a. This can be done safely. b. The Fire Department has not yet arrived.

8. Buildings with red squares on the outside will have fire extinguishers. No one will be allowed to enter a burning building to get a fire extinguisher.

9. If the Kitchen, sleeping quarters, or other vital services are interrupted because of a fire, the NYS Department of Health will be notified and the camp evacuated.

10. In the event of evacuation due to the loss of property by fire, the Camp Administrator or designee will call each camper’s family. If transportation is not available from the parents or guardians, the Camp Administrator or his designate will be responsible for returning each camper to his or her home.

11. If campers are in immediate danger because of a fire, they will be moved by staff automobiles to the Tyrone Fire House or any other place designated by the Sheriff’s Department.

12. If the camp needs to be evacuated, campers shall stay in their designated areas (as long as it is safe to do so) and drivers will bring the cars to them and exit the camp to the Fire Hall.

13. If an evacuation by food is needed, the Administrator will indicate a route based upon the safest at the time. Most likely this would be through the Camp to Cemetery Road and then south to the Fire Hall.

14. The Assistant Camp Administrator shall lead the group to the Fire Hall. The Administrator shall be the last to leave the Camp. Roll call will be taken before and after the move.

Evacuation: Rescuing, removing and accounting for all present must be the first priority. A fire is the most likely reason for the evacuation of buildings or the property. However, the following procedures may also be used for other emergencies or disasters requiring evacuation, such as floods and storm damage.

The first priority is for the evacuation of building(s) and the accounting of all persons. Trained staff should only attempt firefighting when a fire is small and presents no risk to the staff member attempting to extinguish it. No one will be permitted to re-enter a burning building for whatever reason. A rescue attempt of a person from a burning building should be conducted by the fire department.

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Fire drill/evacuation procedures and method of accounting for and supervising campers and staff during emergencies:

• At the sound of the evacuation alarm campers and staff will proceed to the nearest exit in a quick and orderly manner. Upon exiting the building, staff will take attendance of the campers in their charge and proceed in a quick and orderly manner to the designated assembly area. Upon hearing the fire/evacuation alarm during outdoor activities counselors will immediately stop the activity, take attendance and proceed to the assembly area.

• The minimum counselor to camper ratio for general activities will be maintained. Staff will maintain visual and/or verbal communication with campers and ensure that all campers are safe and accounted for. Upon reaching the assembly area each counselor will account for all campers in their charge. Counselors will immediately notify the camp director of any unaccounted for camper and provide information about where the camper was last seen. Attendance to account for all staff and verify that all campers in their charge are accounted for will be taken. Upon identifying a missing person, the lost camper plan will be implemented and the Fire Department immediately notified.

The Assistance Administrator is responsible to preside over the fire drill and for filling out FORM E.1.

Drills must run smoothly and rapidly. Fire drills must be conducted within the first 48 hours of each camp session; if campers arrive late, be certain they receive this training. A log with drill dates and times must be maintained on-site and verified by the Administrator (FORM E.1). It is recommended you conduct drills from various buildings at varying hours with staff prior to the arrival of campers to identify and eliminate potential exiting problems.

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Archery Activity-Specific Plan

Camp Name: Lamoka Baptist Camo Date: 3/1/2019

Prepared by: Greg Howard Title: Director/Administrator

Phone number: 607-463-0324 Email: camp@lamoka.com

Signature: Greg Howard

For Health Department Use Only

Approved: ☐ Yes ☐ No Reviewer: Date: Comments:

Complete the following plan for each archery activity that campers participate in. Submit the completed plan to the local health department or State District Office that has jurisdiction in the county where the camp is located for review. A copy of the approved plan must be maintained at the camp and reviewed by the activity leader prior to overseeing the activity.

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For on-site archery activities, the activity leader must be at least 18-years-old and competent in archery activities including, but not limited to; use and maintenance of equipment, proper constructing of a shooting range, and instruction of correct shooting techniques. When archery is conducted at a location where the camp staff certified in first aid and CPR are not readily available, the activity leader must possess or be accompanied by staff who possesses current first aid and CPR certification in an approved course. NYSDOH Fact Sheets listing approved CPR and First aid certifications are available by contacting your local health department or at www.health.ny.gov/environmental/outdoors/camps.

➢ List the required prerequisites for the activity leader (e.g. training, skills, experience,

certification):

☐ Minimum age: ☒ 18 years-old ☐ 21 years-old or older ☐ Other (specify):

☒ Experience (specify in number of weeks or other quantifiable time period): 2 weeks

☐ Certification(s) (specify):

☒ Training (specify): Trained by the director to strictly adhere to this archery plan and any other applicable portions of the safety plan. The training will go over firing line, safety line, archery field measurements, bow safety, retrieval safety, firing safety, etc.

☐ Other Skill or knowledge required (specify):

➢ Does the activity leader need to possess or be accompanied by staff who possesses current first

aid and CPR certifications for this activity?

☐ Yes ☒ No

Subpart 7-2 requires that an archery staff-to-camper ratio of one for every 10 campers on the firing line is maintained and that all archery staff possess training in archery. A minimum of one activity leader and one staff member must supervise activities that occur at locations where additional camp staff assistance is not readily available (within five minutes).

➢ What ratio of counselors to campers will be maintained?

☒ 1:8 for campers younger than 8-years-old ☒ 1:10 for campers 8-years and older

☐ Other (specify)

➢ Supervision – describe any specific duties of the activity leader, counselors and other specialty staff (if any) for this activity.

☐ None

Teach archery safety and guide the campers through the process safely.

➢ List participant prerequisites (e.g. training, skills, experience, age). Check all that apply.

☒ Campers and archery staff must complete a safety orientation that includes:

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• Procedures for firing and retrieving arrows

• Safety rules (e.g. never shoot arrows up in the air, only shoot at targets, obey shooting and retrieval commands, non-shooters must remain behind ready line)

• How to string a bow

• Inspection of equipment

• Other (specify)

☒ Demonstrate the ability/maturity to follow directions and safety rules

☒ Must be a minimum of 7 years old (specify)

☐ Other participant prerequisites (list):

➢ What safety equipment is required to be used by participants?

☐ Stringer ☐ Armguard ☐ Tabs (to protect fingers) ☐ Chest protector

☐ Other (specify)

The archery range must not endanger any person or persons in other program activities and be clearly marked to warn passing campers away from the danger area. The shooting area must have at least 50 yards of clearance or archery net behind each target. Archers must fire from a common firing line and a ready line shall be marked behind it. The range should be setup so that shooters are not facing into the sun. The bows and arrows must be stored in a locked cabinet.

➢ Who is responsible for the setup and maintenance of the archery range and warning signs to

ensure that the use of the range does not endanger participants or bystanders?

☒ Activity leader ☐ Camp Director ☐ Other (specify)

➢ What safety rules will be employed at the archery range?

• Campers not shooting and spectators must be kept behind the ready line.

• Shooters are required to straddle the shooting line to prevent accidents caused by shooting from behind another person

• Only arrows with target tips will be used. Broadhead arrow points, which are used for hunting, will not be allowed.

• No one will cross the firing line to retrieve arrows until signaled by the activity leader or designated staff. The command to retrieve arrows will only be made after all shooters on the firing line have fired all their arrows and set their bow down.

☒ Check to indicate agreement with the above safety rules. Specify additional or alternative safety rules in the space provided below.

➢ How often does the archery staff inspect the equipment for damage (arrow, bows, etc.)?

☒ Prior to each day’s use ☐ Weekly ☐ Other (specify)

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Boating Activity-Specific Plan

Camp Name: Lamoka Baptist Camp Date: 3/1/2019

Prepared By: Greg Howard Title: Director/Administrator

Phone number: 607-463-0324 Email: camp@lamoka.com

Signature: Greg Howard

In addition to Subpart 7-2 of the NYS Sanitary Code, boats operated at children’s camps must comply with NYS

Navigation Law, which contains requirements for the inspection, operation, and reporting of injuries associated

with public vessels. Contact the Marine Services unit of the NYS Office of Parks, Recreation and Historic

Preservation (OPRHP) at 518-474-0445 or visit their website at www.nysparks.state.ny.us/boating/services.asp

for questions or additional information regarding NYS Navigation Law and public vessel licensure and

inspection.

Definition of a Public Vessel

As stated by the New York State Navigation Law, the term "Public Vessel" shall mean and include every vessel

which is propelled in whole or in part by mechanical power and is used or operated for commercial purposes on

the navigable waters of the state; that is either carrying passengers, carrying freight, towing, or for any other use

for which compensation is received, either directly or where provided as an accommodation, advantage, facility,

or privilege at any place of public accommodation, resort, or amusement. (Section 2.6(a), NYS Navigation Law)

For Health Department Use Only

Approved: ☐ Yes ☐ No Reviewer: Date: Comments:

Complete the following plan for each boating activity that campers participate in. Use additional sheets if necessary. For offsite locations, complete the Activity-Specific Plan for Camp Trips. Submit the completed plan to the local health department or State District Office that has jurisdiction in the county where the camp is located for review. A copy of the approved plan must be maintained at the camp and reviewed by the activity leader prior to overseeing the activity.

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Boating is a popular activity at many children’s camps. In addition to providing hours of enjoyment, boating

activities also include the risk of injury or drowning.

A camp boating activity or trip leader is required to oversee all watercraft activities. The leader must be least 18

years-old, experienced, and competent in the type of boating activity they are overseeing. NYSDOH Supervision

of Boating Activities Fact Sheet provides factors to consider when selecting a camp’s boating activity or trip

leader including age, maturity, training, and certifications. It is available at

www.health.ny.gov/environmental/outdoors/camps/boating_fact_sheet.htm or from your local health

department.

Lifeguards are a valuable addition to staff overseeing boating activities. Lifeguards overseeing boating activities

should receive additional training in watercraft rescue techniques.

A minimum of one activity leader and one staff member must supervise activities that occur at locations where

additional camp staff assistance is not readily available (within five minutes).

When the activity is conducted at a location where the camp staff certified in first aid and CPR are not readily

available, the activity leader must possess or be accompanied by staff who possesses current first aid and CPR

certification in an approved course. NYSDOH Fact Sheets listing approved CPR and First aid certifications are

available at www.health.ny.gov/environmental/outdoors/camps or by contacting your local health department.

Complete a Boating Activity table for each boating activity that campers participate in. Types of boating with the same supervision and safety procedures may be listed together. Use additional sheets if necessary.

Boating Activity

Type of Boating

☐ Row ☒ Sail ☒ Canoe ☒ Kayak ☐ Motor ☒ Paddle ☐ Other (specify):

Location ☒ On-site ☐ Off-site (specify location):

Type of Water ☒ Flat ☐ Flowing ☐ Surf

☐ White Water (indicate stream classification):

Counselor to Camper Ratio

☒ 1:8 for campers 6-years and older ☒ 1:6 for campers younger than 6 years old

☐ Other (specify):

Required Safety Equipment

☐ None required ☒ Life jacket* ☐ Helmet

☐ Other (specify):

*See the informational text box at the end of this document for guidance on lifejacket usage.

Activity Leader prerequisites (e.g. training,

☒ Minimum age: ☒ 18 years-old ☐ 21 years-old or older

☐ Other (specify):

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skills, experience, certification)

☒ Experience (specify in number of weeks or other quantifiable time period):

15 weeks

☒ Certification(s) (specify): Lifeguard, CPR

☒ Training (specify): Training on all boats available

☒ Other Skill or knowledge required (specify): experience on all boats available

Is a lifeguard required?

☐ Yes ☒ No

If yes, how many and where will they be positioned?

Are CPR and first aid staff required?

☐ Yes ☒ No

Participant Prerequisites (Training, Skills, Age, etc.)

☐ None ☐ Classified as a “swimmer” ☒ Minimum of 7 years old

☒ Activity safety orientation ☐ Boater safety course

☐ Demonstrate ability to properly leave and re-enter a swamped boat

☐ Other (specify):

Specify safety rules or precautions.

No running anywhere at the waterfront. No swimming on boat dock side. Campers are not allowed on docks without permission and a lifejacket, all boating activities require a lifejacket. No horseplay. No food, candy, drinks, or gum on the boat dock.

Supervision – Specify how staff, counselors, and specialty activity staff (if any) coordinate the supervision of campers during this activity. For flowing bodies of water, indicate procedures for keeping the group together and positioning of staff. For flat water, indicate areas that are off limits and positioning of staff to ensure complete surveillance.

At least one boat dock staff member will help campers get the right lifejackets on and tightened to the appropriate amount. At least one counselor (or as many as are needed to fulfil ratio requirements stated above) will be assigned to watch campers and do crowd control at the boat dock. This counselor and/or boat staff member will position themselves in such a way to keep kids from going onto docks without permission. The activity leader will be on hand to oversee all activities and to aid if there is a need.

Indicate procedures for emergencies such as a capsized boat.

Non-motorized boats must stay within a range of the boat dock that allows them to easily hear the boat dock staff. If a boat capsizes or if there is an emergency the boat dock staff will then be able to communicate with the campers who are in boats. Staff will be deployed to get campers and a boat if it is capsized.

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Specify additional policies and procedures for the boating activity.

Boating Activity

Type of Boating

☐ Row ☐ Sail ☐ Canoe ☐ Kayak ☒ Motor ☐ Paddle

☐ Other (specify):

Location ☒ On-site ☐ Off-site (specify location):

Type of Water ☒ Flat ☐ Flowing ☐ Surf

☐ White Water (indicate stream classification):

Counselor to Camper Ratio

☒ 1:8 for campers 6-years and older ☒ 1:6 for campers younger than 6 years old

☐ Other (specify):

Required Safety Equipment

☐ None required ☒ Life jacket* ☐ Helmet

☐ Other (specify):

*See the informational text box at the end of this document for guidance on lifejacket usage.

Activity Leader prerequisites (e.g. training, skills, experience, certification)

☐ Minimum age: ☒ 18 years-old ☐ 21 years-old or older

☐ Other (specify):

☒ Experience (specify in number of weeks or other quantifiable time period):

At least 20 hours of driving boat.

☒ Certification(s) (specify): PV Drivers License

☐ Training (specify):

☐ Other Skill or knowledge required (specify):

Is a lifeguard required?

☐ Yes ☒ No

If yes, how many and where will they be positioned?

Are CPR and first aid staff required?

☐ Yes ☒ No

Participant Prerequisites (Training,

☐ None ☐ Classified as a “swimmer” ☐ Minimum of years old

☒ Activity safety orientation ☐ Boater safety course

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Skills, Age, etc.)

☐ Demonstrate ability to properly leave and re-enter a swamped boat

☐ Other (specify):

Specify safety rules or precautions.

All campers will board the motorized boat(s) only when given permission to do so. All campers will remain seated when boat is in motion. All campers will wear lifejackets for the entire ride and until they get off the boat. No horseplay. Boat rides will not exceed 30 miles per hour.

Supervision – Specify how staff, counselors, and specialty activity staff (if any) coordinate the supervision of campers during this activity. For flowing bodies of water, indicate procedures for keeping the group together and positioning of staff. For flat water, indicate areas that are off limits and positioning of staff to ensure complete surveillance.

A trained over 18 year old with a PV and boater safety course will pilot the boat and enforce rules on the boat during boat rides.

Indicate procedures for emergencies such as a capsized boat.

If the boat capsizes, campers and staff will swim toward each other and take role call to make sure all campers and staffers are accounted for. They will then make their way to the nearest shore line, where they will call for help or return to campus on foot.

Specify additional policies and procedures for the boating activity below.

Boating Activity

Type of Boating

☐ Row ☐ Sail ☐ Canoe ☐ Kayak ☐ Motor ☐ Paddle

☐ Other (specify):

Location ☐ On-site ☐ Off-site (specify location):

Type of Water ☐ Flat ☐ Flowing ☐ Surf

☐ White Water (indicate stream classification):

Counselor to Camper Ratio

☐ 1:8 for campers 6-years and older ☐ 1:6 for campers younger than 6 years old

☐ Other (specify):

Required Safety Equipment

☐ None required ☐ Life jacket* ☐ Helmet

☐ Other (specify):

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*See the informational text box at the end of this document for guidance on lifejacket usage.

Activity Leader prerequisites (e.g. training, skills, experience, certification)

☐ Minimum age: ☐ 18 years-old ☐ 21 years-old or older

☐ Other (specify):

☐ Experience (specify in number of weeks or other quantifiable time period):

☐ Certification(s) (specify):

☐ Training (specify):

☐ Other Skill or knowledge required (specify):

Is a lifeguard required?

☐ Yes ☐ No

If yes, how many and where will they be positioned?

Are CPR and first aid staff required?

☐ Yes ☐ No

Participant Prerequisites (Training, Skills, Age, etc.)

☐ None ☐ Classified as a “swimmer” ☐ Minimum of years old

☐ Activity safety orientation ☐ Boater safety course

☐ Demonstrate ability to properly leave and re-enter a swamped boat

☐ Other (specify):

Specify safety rules or precautions.

Supervision – Specify how staff, counselors, and specialty activity staff (if any) coordinate the supervision of campers during this activity. For flowing bodies of water, indicate procedures for keeping the group together and positioning of staff. For flat water, indicate areas that are off limits and positioning of staff to ensure complete surveillance.

Indicate procedures for emergencies such as a capsized boat.

Specify additional policies and procedures for the boating activity below.

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Life Jackets. They Float. You Don't!

Wearing your life jacket (life vest or personal flotation device - PFD) can save your life! When boating, occupants seldom expect to find themselves in the water; but if they do, and are not wearing a life jacket, they increase their chance of becoming a boating statistic. Approximately 83 percent of the people who died in boating accidents in the United States in 2016 were not wearing life jackets. Since 1985, New York State has required all boat occupants at children's camps to WEAR United States Coast Guard-approved life jackets. No camper boating deaths have occurred since 1980 in New York State.

What Type is Right?

The following types are all accepted as meeting the life jacket requirements for NYS children's camps. Look for the United States Coast Guard (USCG) approval and type on the label.

Type I - Offshore Life Jacket: Designed for large, rough waters where rescue may not be prompt and to turn most unconscious wearers face up. These PFDs are most often found on commercial crafts. They tend to be bulky.

Type II - Near Shore Buoyant Vest: Less bulky and providing less floatation than Type I, these vests are for use in calm inland waters where there is a chance of fast rescue; vest will turn some wearers face up.

Type III - Flotation Aids: Generally the most comfortable type of life jacket. This type includes many activity specific designs (i.e. water skiing, fishing, sailing, etc.), so be sure to check the label. They are not designed to turn the unconscious wearer face up, but will keep the wearer upright in the water.

Type V – Special Use Hybrids: A Type V is any approved device designed for specific and restricted use. The specific approved use of a Type V and any restricted or limitations will be described on the device label. Some Type V PFDs are, under certain conditions, approved as a replacement for a Type III or other device, usually with the provision that they be worn.

Inflatable PFDs The USCG does approve inflatable PFDs for use on recreational vessels; however, they are not allowed for non-swimmers, water skiers, and youths under the age of 16 or riders of personal watercraft. Inflatable PFDs require the user to pay careful attention to the condition of the device. Inflatable PFDs must have a full cylinder and all status indicators on the inflator must be green, or the device is not acceptable. The wear must also read the approval label to determine if it is suitable for the water activity being conducted.

Belt pack inflatable PFDs are Type V life jackets with Type III performance because you have to slip the inflated chamber over your head. The wearer must be conscience in order to place the jacket over their head. Hybrid (Foam & Inflation)

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Hybrid PFDs can be used by swimmers & non-swimmers. This form of PFD comes with a foam-padded vest with an inflatable bladder, sort of a type III and an inflatable type V. As with all other types of PFDs they come in Adult, Youth, and Child sizes. The USCG approval is for wearable styles only; they must be worn to be considered an approved device. The wearer must also read the approval label to determine if this type of PFD is suitable for the water activity they are participating in. Some are designed for specific water sports.

The Fit is It!

When you select life jackets for your children's camp and to fit individuals, keep in mind they must be sized appropriately. Read the label to determine the size and weight restrictions. Life jackets should be adjusted to fit snugly. To determine this, lift the shoulders of the life jacket; it's too big if there is more than three inches between the shoulders of the wearer and the device, or if the device slips over the chin or ears. The use of straps between the legs is an important feature on life jackets for small children.

Check Life Jackets

Check flotation characteristics at the beginning of each season. Depending on materials, care and use, there is a potential for buoyancy loss. Test: fit the jacket to the wearer and have them walk gradually into the water until it completely supports the wearer. If the PFD floats the person out of the water and feels comfortable, the device is still usable. Check the materials for wear and tear, pulling seams, straps and buckles for strength. Kapok filled jackets should be checked for air leaks/moisture, which causes the Kapok to deteriorate and lose buoyancy. Discard when in doubt. Dry life jackets and store out of the sun, away from chemicals such as gasoline or oil. Information provided by the U.S. Coast Guard and the National Safe Boating Council.

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Camp Trips Activity- Specific Plan

Camp Name: Lamoka Baptist Camp Date: 3/1/2019

Prepared By: Greg Howard Title: Director/Administrator

Phone number: 607-463-0324 Email: camp@lamoka.com

Signature: Greg Howard

For Health Department Use Only

Approved: ☐ Yes ☐ No Reviewer: Date: Comments:

Complete this plan for each out-of-camp trip. Additionally, if the camp trip includes swimming, boating or horseback riding, complete the corresponding Activity-Specific Plan for that activity. Submit the completed plan to the local health department or State District Office that has jurisdiction in the county where the camp is located for review. A copy of the approved plan must be maintained at the camp and reviewed by the trip leader prior to overseeing the activity.

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1. Destination of camp trip: Sugar Hill/Finger Lake Trails, Watkins Glen NY

2. Duration of trip: ☐ Half-day ☐ Day trip

☒ Overnight trip (indicate number of days) 1.5

The children's camp operator remains responsible for meeting State Sanitary Code requirements at an “off-site” location used during camp trips and for camper protection. Staff supervising a camp trip must review the camp safety plan for each trip within 24 hours prior to departure, except when the staff participated in an identical trip or in the pre-camp training within one week prior to the intended trip. Make pre-arrangements with off-site facilities well in advance to:

➢ Obtain facility rules and requirements.

➢ Ensure the facility is able to accommodate the camp. Provide the facility information about your group, including the age and number of campers in your group.

➢ Determine the best time(s) for your visit and what area(s) the campers may and may not use.

➢ Determine what role, if any, the off-site facility will play in implementing your safety plan.

➢ Exchange key contact information with the facility, including the camp’s address and emergency telephone number(s) and name(s) of camp staff who will oversee the camp group at the facility.

You should confirm your arrangements in writing with the facility and maintain the written agreement on file. When the same individual (operator) oversees the children’s camp and off-site facility, a written agreement is not necessary; however, arrangements must still be made. If possible, visit the facility prior to taking campers there.

3. Provide a description of the camp trip, include estimated duration and activities planned for

each stop. If there is a written agreement for use of the trip site, attach it.

Campers will leave in two vans on Thursday and arrive at Sugar Hill State Park (the fire tower and red area) (Finger Lakes Trail) in the afternoon. Campers and staff will unload vans and hike into the forest on the Finger Lakes Trails for the evening, eating dinner on the trail. The campers and staff will then camp and sleep in tents at a designated camp site on the trail (leanto). They will eat breakfast in the morning, breaking camp immediately after. They will then hike back to the drop off location (the same way they came), load up vans, and return to Camp Lamoka before lunch on Friday.

Trip leader – A trip leader must be at least 18 years of age and have participated in at least three camp trips in a similar program activity as a children’s camp staff member, or have experience and training in the activity which the local health department has determined to be equivalent to three camp trips. (For approval of experience and training as being equivalent to three camp trips, complete and submit the form at the end of this Appendix to your local health department.)

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Trip leaders for wilderness, equestrian, boating and similar specialized activities must be competent in the activity. The camp may rely on off-site facility staff or venders to provide competent staff in the activity; however, the camp must still provide a qualified trip leader (age and experience) to oversee camper supervision and implementation of the safety plan. A trip leader of a camp trip with an itinerary that includes an activity where emergency medical care is not readily available (within five minutes), and/or an activity such as wilderness hiking, camping, rock climbing, horseback riding, bicycling, swimming and/or boating, must possess or be accompanied by staff who possesses current first aid and CPR certification in an approved course. NYSDOH Fact Sheets listing approved CPR and First aid certifications are available at www.health.ny.gov/environmental/outdoors/camps or by contacting your local health department.

4. List the required prerequisites for the trip leader (e.g. training, skills, experience, certification):

☐ No specialized prerequisites required

☒ Minimum age: ☐ 18 years-old ☒ 21 years-old or older ☐ Other (specify):

☒ Experience (specify in number of weeks or other quantifiable time period): 5+ wilderness trips

☐ Certification(s) (specify):

☐ Training (specify):

☒ Other Skill or knowledge required (specify): Experience on the Finger Lake Trails.

5. Does the trip leader need to possess or be accompanied by staff who possesses current first aid

and CPR certifications for this activity?

☒ Yes ☐ No

6. For wilderness, equestrian, boating and similar specialized activities, will the camp or off-site facility/vendor provide competent staff to oversee the activity?

☒ Camp ☐ Off-site facility/vendor ☐ N/A (specialized staff not required)

A trip leader and at least one counselor must accompany all camp trips. A minimum counselor-to-camper ratio of 1:8 must be maintained for swimming, wilderness, equestrian, boating and similar specialized trips, unless the children are less than six years of age; then the ratio must be 1:6. A minimum counselor-to-camper ratio of 1:12 must be maintained when transporting campers via motor vehicles to a specific activity site.

7. What ratio of counselors to campers will be maintained for the trip?

☐ 1:8 for campers 6 and older and 1:6 for campers 5 and younger

☒ 1:8 for campers younger than 8-years-old and 1:10 for campers 8-years and older

☐ 1:12 (day camps)

☐ Other (specify)

8. List participant prerequisites, if any (e.g. training, skills, experience, age). For swimming, boating and horseback riding, complete the corresponding Activity-Specific Plan.

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☐ No participant prerequisites

☒ Campers and participating staff must complete a safety orientation that includes (list): Hiking and wilderness safety.

☒ Must be a minimum of 10 -years-old (specify)

☐ Other (specify)

9. How will campers be accounted for and supervised?

Prior to departure, the trip leader will prepare a roster of all campers (first and last name) attending the trip and counselors will be provided a list of specific campers assigned to them to supervise during the trip. Counselors will maintain visual or verbal contact with assigned campers for the entire trip. Campers will be paired with a buddy prior to leaving the camp and instructed to stay with that buddy at all times and notify the nearest staff person if their buddy is missing or hurt. The trip leader will take attendance prior to leaving the camp and prior to departing from each stop to ensure that no camper is left behind. Counselors will take frequent attendance of campers in their charge and prior to moving between activities during the trip.

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided):

10. What safety equipment is required for the activities conducted during the trip? For swimming, boating and horseback riding, complete the corresponding Activity-Specific Plan.

☒ No safety equipment needed

Activity

Required Safety Equipment

Equipment Provided By Helmet

Elbow / Knee Pads

Safety Goggles

Long Pants

PFD Other

☐ ☐ ☐ ☐ ☐ ☐ Camp

☐ Vendor

☐ ☐ ☐ ☐ ☐ ☐ Camp

☐ Vendor

☐ ☐ ☐ ☐ ☐ ☐ Camp

☐ Vendor

☐ ☐ ☐ ☐ ☐ ☐ Camp

☐ Vendor

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11. List the rules and/or safety precautions for the activities conducted during the trip.

The trip leader and multiple other staff members will carry cell phones for the entire trip. The campers will always be in visual range of the staff and trip leader. Campers will follow all other camp rules (e.g. no horseplay, no inappropriate language, no touching animals, to climbing trees, etc…)

12. How will medication be administered during the trip?

☐ The camp’s Health Director will accompany the trip and coordinate and administer medications in accordance with the Medication Administration section of this document.

☒ The trip leader or other designee will coordinate and oversee the administration of medications in accordance with the Medication Administration section of this document.

☐ Alternative procedures (specify):

13. Describe provisions made for routine medical care and emergencies during the trip?

A CPR and First Aid certified individual will accompany the group on the trip. He will carry with him a first aid kit. In an emergency, phones will be used to call for help.

14. What is the lost camper plan for this trip?

Prior to the trip or immediately upon arrival at the location, the Trip Leader will identify a specific area or location for campers to go if they become separated from the group. Campers will be instructed to notify the nearest facility staff member, if available, that they have become separated from the camp group and to go with a facility person to the meeting location.

In the event that a camper becomes lost or unaccounted for, the Lost Camper Plan specified in the General and Activity Specific Safety section of this document will be activated.

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided):

15. If the trips are into wilderness or off-road areas, what provisions are made for communication with the camp?

☒ Cell phone ☐ Two-way-radio ☐ Other (specify)

16. When off-site how will food be transported, stored, refrigerated, cooked, prepared, etc.? What types of foods? Is drinking water provided? Where is it obtained?

1) FOOD: Food will be stored and carried by the campers and staff on the trip. No raw meat or refrigerated foods will be taken. Examples of food that will be taken: Trail Mix, Granola, instant

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mac and cheese, instant oatmeal, energy bars, dry foods, etc... 2) WATER: Bottles of water will be carried by all campers and staff. Extra water will be taken in case of emergency.

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Rope and Challenge Course Activity-Specific Plan

Camp Name: Lamoka Baptist Camp Date: 3/1/2019

Prepared by: Greg Howard Title: Director/Administrator

Phone number: 607-463-0324 Email: camp@lamoka.com

Signature: Greg Howard

For Health Department Use Only

Approved: ☐ Yes ☐ No Reviewer: Date: Comments:

Complete the following plan for rope and challenge course activities that campers participate in. Submit the completed plan to the local health department or State District Office that has jurisdiction in the county where the camp is located for review. A copy of the approved plan must be maintained at the camp and reviewed by the activity leader prior to overseeing the activity.

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The New York State Department of Labor (DOL) rules and regulations, 12 NYCRR Part 45, for Amusement Devices apply to zip lines, high rope courses, climbing walls with mechanical belays, canopy tours, euro bungees, water slides 20 feet tall and higher, and similar non-motorized devices (including giant swings) operated at a children’s camp. The New York State Departments of Health (DOH) and DOL have established a policy to eliminate duplicative inspection and oversight responsibilities of these activities when they are operated at the camp for its exclusive use. This allows the camp operator to elect to have the physical structure and operation of qualifying amusement device to be permitted by DOL or DOH. If a covered amusement device is open to the public during the camp season or operated outside of the timeframe of the camp permit, the operator must obtain a DOL permit for its operation. For additional information including construction and annual inspection requirement for amusement devices and similar equipment at camps, refer to the Fact Sheet available at www.health.ny.gov/environmental/outdoors/camps/amuse.htm or from your local health department.

Regardless of which agency oversees the physical structure and operation of an amusement device, the camp must establish safety requirements and supervision policies and procedures in accordance with Subpart 7-2.5(n)(5) of the State Sanitary Code.

The activity leader for a rope and challenge course must be competent in the course activities available at the camp, including but not limited to: equipment’s function, use and maintenance; belaying and spotting techniques; and communication/signals. A minimum of the activity leader and one staff member must supervise activities that occur at locations where additional camp staff assistance is not readily available (within five minutes). When the activity is conducted at a location where the camp staff certified in first aid and CPR are not readily available, the activity leader must possess or be accompanied by staff who possesses current first aid and CPR certification in an approved course. NYSDOH Fact Sheets listing approved CPR and First aid certifications are available at www.health.ny.gov/environmental/outdoors/camps or by contacting your local health department.

➢ List the required prerequisites for the activity leader (e.g. training, skills, experience, certification):

☐ Minimum age: ☒ 18 years-old ☐ 21 years-old or older ☐ Other (specify):

☒ Experience (specify in number of weeks or other quantifiable time period): 1 season/6 weeks

☒ Certification(s) (specify): CPR and First Aid

☒ Training (specify): ACCT equivalent training for climbing wall and zipline

☐ Other Skill or knowledge required (specify):

➢ Does the activity leader need to possess or be accompanied by staff who possesses current first aid and CPR certifications for this activity?

☒ Yes ☐ No

➢ What ratio of counselors to campers will be maintained?

☐ 1:6 for campers younger than 6-years-old ☒ 1:8 for campers 6-years and older

☐ Other (specify)

➢ Supervision – describe any specific duties of the counselors for this activity.

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☐ None

☒ Specific duties (specify) Crowd control.

An operation manual, which specifies the operation, maintenance, and daily inspection requirements for use and is consistent with industry standards, must be provided by the ropes or challenge course manufacturer and maintained on-site at the camp. Where such a manual does not exist, it should be created by an industry professional knowledgeable in the safe operation of the device. The operator must maintain records documenting compliance with the schedule/requirements. Zip lines, high rope courses, climbing walls, canopy tours and similar devices must be designed and inspected after construction and prior to use annually thereafter by a third-party certified Association for Challenge Course Technology (ACCT) Professional Vendor Member, ACCT Professional Inspector, Professional Ropes Course Association (PRCA) Accredited Vendor, a person certified by the National Association of Amusement Ride Safety Officials, professional engineer, or other certification/accreditation acceptable to DOL. Each device/element must be inspected for the integrity of all hardware, materials, equipment, and the condition of the environment in the vicinity of the device/element by the inspector.

➢ What are the procedures for the inspection and maintenance of the course and all ropes, harnesses,

etc.? Annually prior to the use, and as otherwise specified by the manufacturer of the rope/challenge course, a third-party certified ACCT Professional Vendor Member, ACCT Professional Inspector, PRCA Accredited Vendor, professional engineer, or other certification/accreditation acceptable to DOL will conduct an inspection of all elements and equipment. Any deficiencies identified by the inspector will be rectified prior to its use. Low rope courses and other elements that in their construction do NOT contain critical loadbearing cables, components and/or anchoring systems where failure could result in serious injury, will be inspected annually prior to use by an appropriate individual knowledgeable in their construction, maintenance, and safe use. Any deficiencies or safety issues identified will be rectified prior to use.

Prior to each day’s use the activity leader will inspect all components of each element and equipment (e.g. ropes, harnesses, cables, anchors, trees, lumber) to be used that day. Components will be maintained free of hazards, securely anchored where necessary, installed and used in accordance with manufacturer's instructions. The condition of each element and equipment will be documented. Any element or equipment found to be in disrepair will not be used until replaced or properly repaired.

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

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☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided):

➢ What records do you keep of the amount of service various elements have seen (i.e. how long has a

rope been in use and how many falls has it “caught”)? At what point will equipment be discarded and replaced?

Records will be kept at the Wall and will include how many times a rope has been used and how many falls that rope has “caught.” An inspection of all equipment will be done by a trained professional before each summer. If they indicate that something should be discarded or replaced, it will be discarded or replaced. ➢ Who will train staff prior to the season in the skills (spotting, belaying, rescue, emergency

procedures, etc.) needed to operate the course?

☒ An experienced challenge course professional knowledgeable in current industry standards (e.g. ACCT, PRCA) and familiar with the proper operation and use of elements offered at the camp.

☒ Camp staff will be used to supplement training provided by the challenge course professional.

☐ Other (specify certification or qualifications)

➢ What training is given to campers prior to their participation?

Prior to using any elements at the ropes/challenge course, campers will be instructed by the activity leader in terminology, equipment function and use, spotting and belaying techniques, and communication commands/signals used on the course. Prior to a camper’s first use of an element, the activity leader will demonstrate and provide instruction in the specific procedures for that element, including but not limited to: safety equipment use, preflight check requirements (if any), and the spotting or belaying technique used for that element.

☒ Check to indicate agreement with the above procedure. Specify additional procedures in the space provided below.

☐ Alternative procedures (when the above procedure is not utilized, a comprehensive alternative must be provided):

➢ What provisions will be made for emergency communications and response for a participant injured at the course?

☒ Two-way radio ☐ Telephone ☒ Cell phone ☐ Other (specify) ➢ Complete the following information for each element. Elements with the same supervision and

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safety procedures may be listed together. Include sketches and pictures of elements as needed. Name of element(s) Swinging platforms, Long Log, Islands, Rope Swing, Bridges, Cable Walk, V Trust

Walk, The Web, The Crossover, Vertical Pole, All Aboard

Participant prerequisites (age, height, skills, etc.)

☐ Minimum age ☐ Minimum height

☐ Minimum weight ☐ Maximum weight

☒ Other (list) No prerequisites were prescribed by the ACCT trainer Required safety equipment

☐ Helmet ☐ Gloves ☐ Harness

☐ Other (list) Specify the number and positioning of required staff

2 staff, positioned according to the ACCT training for spotting Describe the safety rules and procedures (spotting, belaying, preflight checks, etc.)

All elements are inspected daily by the activity leader. 2 spotters are positioned at each element while it is being used. Low Ropes Rules: 1. Treat the course, elements, and challenges with respect. 2. You may not be in the Low Ropes Course or on any elements without permission. 3. You may not be in the low ropes Course or on any element unless you are accompanied by Low Ropes Staff. 4. You may not chew gum, eat, or drink while participating in any of the challenges. 5. Walk on the MARKED paths only 6. Listen to and follow all commands and rules given to you by the program or low ropes staff.

Name of element(s) Climbing Wall

Participant prerequisites (age, height, skills, etc.)

☒ Minimum age 7 ☐ Minimum height

☐ Minimum weight ☐ Maximum weight

☐ Other (list) Required safety equipment

☒ Helmet ☐ Gloves ☒ Harness

☐ Other (list) Specify the number and positioning of required staff

Staff will help harness, do crowd control, and explain rules and procedure to the campers before the activity begins. These staff members will stay on site during the activity.

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Describe the safety rules and procedures (spotting, belaying, preflight checks, etc.)

A first aid kit must be at the site of the Climbing Wall when in operation. To climb the wall, participants will enter the safety zone/climbing zone (inside the brown fence) one at a time. They will not enter until they are harnessed, have the safety helmet on, and are directed to do so by the Climbing Wall staff. The one belaying will have taken a class and have adequate experience in belaying. Participants will have the belay on for the entire duration of the course or climb. Counselors will be trained in harnessing of the participant. The one belaying will look for signs of fatigue and health difficulties in their climber and instruct the participant to stop. The one belaying will inspect the knot on the belay rope and harness on the participant before each climb. Climbing Wall Rules: 1. All climbers will wear a harness and helmet inside the fence (safety zone) at all times. 2. Before the participant begins to climb, the climber must say "on belay" and "ready to climb" with responses from the belayer being "belay is on" and "climb on," respectively. 3. No one will go behind the fence unless directed to do so by a belayer or staff member. 4. Listen to and obey the climbing wall staff at all times.

Name of element(s)

Participant prerequisites (age, height, skills, etc.)

☐ Minimum age ☐ Minimum height

☐ Minimum weight ☐ Maximum weight

☐ Other (list) Required safety equipment

☐ Helmet ☐ Gloves ☐ Harness

☐ Other (list) Specify the number and positioning of required staff

Describe the safety rules and procedures (spotting, belaying, preflight checks, etc.)

Name of element(s) Zipline

Participant prerequisites (age, height, skills, etc.)

☐ Minimum age ☐ Minimum height

☒ Minimum weight 70 ☒ Maximum weight 250

☐ Other (list) Required safety equipment

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☒ Helmet ☒ Gloves ☒ Harness

☐ Other (list) Specify the number and positioning of required staff

Staff will harness and belay zip line participants to the top of the wall, A staff member trained and certified on the zipline will accompany participants on the zipline (all the way through to the end).

Describe the safety rules and procedures (spotting, belaying, preflight checks, etc.)

Serious injuries must be reported to both the Health Department and the Department of Labor -(518) 457-3518. If a serious injury occurs, the device must be shut down and not used until Lamoka gets approval to re-open the device from the DOL. If the serious injury occurred as a result of faulty hardware, the device must not be re-opened until the hardware is replaces or repaired. Along with Zip Line Rules, a legible sign will be posted containing “warnings that there are inherent risks in the participation in or on the amusement device, since it is recognized that participation in or on the device may be hazardous regardless of all feasible safety measures that can be undertaken by the device owner or operator; and that there is a duty for the patrons to become apprised of the warnings and the risks inherent in participation in or on the amusement device if the warnings are not obeyed. Prior to participation in or on such amusement device, patrons shall familiarize themselves with the posted safety warnings so that they may make an informed decision of whether to participate in or on the device notwithstanding the risks.” (An excerpt from DOL Rule 45) Zip Lines will not be used without adequate illumination. The Zip Line will be inspected by a certified inspector from the DOL and a Load Test will be conducted before the Zip Line is used. Zip Line Course Rules: 1. All participants, including staff, will wear safety equipment provided by Lamoka Baptist Camp (absolutely no personal equipment is allowed on the course.). 2. Participants must remain connected to cables or safety lines at all times while on elevated platforms. 3. Participants must wear closed-toe shoes. 4. Participants are required to strictly adhere to all zip lining rules and to listen to staff to ensure safe zip lining 5. All riders must be willing participants. Crying children will not be allowed to zip line. 6. Hair that is long enough to get caught in equipment must be tied back or secured. 7. All participants must sign a waiver of liability. Youth campers are covered by the signature on their Youth Camp Registration, which covers all camp activities. 8. No personal objects will be carried while zip lining (e.g. phone, camera, etc)

Name of element(s)

Participant prerequisites (age, height, skills, etc.)

☐ Minimum age ☐ Minimum height

☐ Minimum weight ☐ Maximum weight

☐ Other (list) Required safety equipment

☐ Helmet ☐ Gloves ☐ Harness

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☐ Other (list) Specify the number and positioning of required staff

Describe the safety rules and procedures (spotting, belaying, preflight checks, etc.)

Name of element(s)

Participant prerequisites (age, height, skills, etc.)

☐ Minimum age ☐ Minimum height

☐ Minimum weight ☐ Maximum weight

☐ Other (list) No prerequisites were prescribed by the ACCT trainer Required safety equipment

☐ Helmet ☐ Gloves ☐ Harness

☐ Other (list) Specify the number and positioning of required staff

Describe the safety rules and procedures (spotting, belaying, preflight checks, etc.)

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Sports Activity-Specific Plan

Camp Name: Lamoka Baptist Camp Date: 3/1/2019

Prepared By: Greg Howard Title: Director

Phone number: 607-463-0324 Email: camp@lamoka.com

Signature: Greg Howard

For Health Department Use Only

Approved: ☐ Yes ☐ No Reviewer: Date: Comments:

Complete this plan for each sport that requires additional supervision or safety procedures from what has been provided in Section V (Supervision and Activity Safety) of the main document (e.g. requires additional/specialized staff, minimum participant prerequisites, safety equipment). Submit the completed plan to the local health department or State District Office that has jurisdiction in the county where the camp is located for review. A copy of the approved plan must be maintained at the camp and reviewed by the activity leader prior to overseeing the activity.

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Check the box for the sport(s) being conducted at the camp (check all that apply):

☐ Baseball ☒ Basketball ☐ Bowling ☐ Cheerleading ☐ Football

☐ Golf ☐ Handball ☐ Ice Hockey ☐ Field Hockey ☐ Lacrosse

☐ Roller Hockey ☒ Soccer ☐ Softball ☐ Tennis ☒ Volleyball

☐ Wrestling ☒ Other (specify): gaga ball, carpet ball, tetherball, box hockey, paintball, and nerf tag, ultimate frisbee, frisbee golf, dodge ball

➢ The activity leader for on-site sporting activities must be competent in the sport they are overseeing.

➢ A minimum of the activity leader and one staff member must supervise activities that occur at

locations where additional camp staff assistance is not readily available (within five minutes).

➢ When the sport is conducted at a location where the camp staff certified in first aid and CPR are not readily available, the activity leader must possess or be accompanied by staff who possesses current first aid and CPR certification in an approved course. NYSDOH Fact Sheets listing approved CPR and First aid certifications are available at www.health.ny.gov/environmental/outdoors/camps or by contacting your local health department.

Complete the following sections for each sport conducted at the camp. Sports with the same supervision and safety procedures may be listed together. Use additional sheets if necessary.

a) Name of sport(s) Basketball, Soccer, Volleyball, Ga Ga Ball, Carpet Ball, Tetherball. Box hockey:

1. List the required prerequisites for the activity leader (e.g. training, skills, experience,

certification):

☒ No specialized prerequisites required

☒ Minimum age: ☐ 16 years-old (day camps only) ☒ 18 years-old

☐ 21 years-old ☐ Other (specify):

☐ Experience (specify in number of weeks or other quantifiable time period):

☐ Certification(s) (specify):

☐ Training (specify):

☐ Other Skill or knowledge required (specify):

2. Does the activity leader need to possess or be accompanied by staff who possesses current first aid and CPR certifications for this activity?

☐ Yes ☒ No

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➢ Camper to Counselor Ratio

☒ 1:8 for campers under 8- years-old ☒ 1:10 for campers 8- years and older

☐ 1:12 (day camps) ☐ Other (specify)

➢ Participant prerequisites (training, age, height, weight, skills, etc.):

☒ Minimum age 7

☐ Sport safety orientation

☐ Other (specify): ➢ Required safety equipment

☒ None ☐ Helmet

☐ Elbow/knee pads ☐ Mouth guard

☐ Other (specify):

➢ Describe the inspection/maintenance requirements for the safety equipment.

☐ No safety equipment needed

➢ Safety rules or precautions taken during the activity

Follow the rules of the activity/sport, no horseplay, listen to counselors and staff.

➢ At a minimum, there must be visual or verbal communications capabilities between campers and counselors at all times during the activity. Describe any specific duties of the activity leader, counselors and other specialty staff (if any) for this activity.

☒ None

b) Name of sport(s) Paintball:

3. List the required prerequisites for the activity leader (e.g. training, skills, experience, certification):

☐ No specialized prerequisites required

☒ Minimum age: ☐ 16 years-old (day camps only) ☒ 18 years-old

☐ 21 years-old ☐ Other (specify):

☒ Experience (specify in number of weeks or other quantifiable time period): 1 week

☐ Certification(s) (specify):

☒ Training (specify): Training on paintball safety and marker safety.

☐ Other Skill or knowledge required (specify):

4. Does the activity leader need to possess or be accompanied by staff who possesses current first aid and CPR certifications for this activity?

☒ Yes ☐ No

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➢ Camper to Counselor Ratio

☒ 1:8 for campers under 8- years-old ☒ 1:10 for campers 8- years and older

☐ 1:12 (day camps) ☐ Other (specify) ➢ Participant prerequisites (training, age, height, weight, skills, etc.):

☒ Minimum age 12

☒ Sport safety orientation

☐ Other (specify): ➢ Required safety equipment

☐ None ☒ Helmet

☐ Elbow/knee pads ☐ Mouth guard

☒ Other (specify): Face mask (part of the helmet), and barrel bags (removed before play)

➢ Describe the inspection/maintenance requirements for the safety equipment.

All equipment is inspected before each use.

☐ No safety equipment needed ➢ Safety rules or precautions taken during the activity

Barrel bags and safeties must be on at all times except during play. Play starts when the ref says "game on" and ends when the ref says "game over." No shooting before or after games begin. No shooting players if they are within 20 feet. When a player is shot, he/she must raise their hands, point their marker up, and exit the field to a designated safe area. No shooting anyone who signals that they are out of play. Masks stay on until the ref says they may be removed - even if you are out of play. Do not shoot the ref. Do not intentionally hit opponents’ mask area (head). It is recommended that players wear long shirts and pants to play. Keep running to a minimum. No one under 12 may play unless accompanied by an adult. No chewing gum or eating food while participating in the activity. Players that do not follow these rules or if they participate in any unnecessary rough play will be removed from the game.

➢ At a minimum, there must be visual or verbal communications capabilities between campers and counselors at all times during the activity. Describe any specific duties of the activity leader, counselors and other specialty staff (if any) for this activity.

They will help referee the games and enforce rules.

☐ None

c) Name of sport(s) Nerf Tag:

5. List the required prerequisites for the activity leader (e.g. training, skills, experience, certification):

☐ No specialized prerequisites required

☒ Minimum age: ☐ 16 years-old (day camps only) ☒ 18 years-old

☐ 21 years-old ☐ Other (specify):

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☐ Experience (specify in number of weeks or other quantifiable time period):

☐ Certification(s) (specify):

☐ Training (specify):

☐ Other Skill or knowledge required (specify):

6. Does the activity leader need to possess or be accompanied by staff who possesses current first aid and CPR certifications for this activity?

☒ Yes ☐ No

➢ Camper to Counselor Ratio

☒ 1:8 for campers under 8- years-old ☒ 1:10 for campers 8- years and older

☐ 1:12 (day camps) ☐ Other (specify) ➢ Participant prerequisites (training, age, height, weight, skills, etc.):

☐ Minimum age

☒ Sport safety orientation

☐ Other (specify): ➢ Required safety equipment

☐ None ☐ Helmet

☐ Elbow/knee pads ☐ Mouth guard

☒ Other (specify): safety glasses

➢ Describe the inspection/maintenance requirements for the safety equipment.

Safety glasses will be examined for breaks or problems before each use.

☐ No safety equipment needed ➢ Safety rules or precautions taken during the activity

Campers will keep running to a minimum. Play starts when the ref says "game on" and ends when the ref says "game over." No shooting before or after games begin. When a player is shot, he/she must raise their hands, point their marker up, and exit the field to a designated safe area. No shooting anyone who signals that they are out of play. Safety glasses must stay on until the ref says they may be removed - even if you are out of play. Do not shoot the ref. Do not intentionally hit opponents’ head area. Keep running to a minimum. No chewing gum or eating food while participating in the activity. Players that do not follow these rules or if they participate in any unnecessary rough play will be removed from the game.

➢ At a minimum, there must be visual or verbal communications capabilities between campers and counselors at all times during the activity. Describe any specific duties of the activity leader, counselors and other specialty staff (if any) for this activity.

Counselors will help ref the games and enforce rules.

☐ None

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d) Name of sport(s) :

7. List the required prerequisites for the activity leader (e.g. training, skills, experience, certification):

☐ No specialized prerequisites required

☐ Minimum age: ☐ 16 years-old (day camps only) ☐ 18 years-old

☐ 21 years-old ☐ Other (specify):

☐ Experience (specify in number of weeks or other quantifiable time period):

☐ Certification(s) (specify):

☐ Training (specify):

☐ Other Skill or knowledge required (specify):

8. Does the activity leader need to possess or be accompanied by staff who possesses current first aid and CPR certifications for this activity?

☐ Yes ☐ No

➢ Camper to Counselor Ratio

☐ 1:8 for campers under 8- years-old ☐ 1:10 for campers 8- years and older

☐ 1:12 (day camps) ☐ Other (specify)

➢ Participant prerequisites (training, age, height, weight, skills, etc.):

☐ Minimum age

☐ Sport safety orientation

☐ Other (specify): ➢ Required safety equipment

☐ None ☐ Helmet

☐ Elbow/knee pads ☐ Mouth guard

☐ Other (specify):

➢ Describe the inspection/maintenance requirements for the safety equipment.

☐ No safety equipment needed ➢ Safety rules or precautions taken during the activity

➢ At a minimum, there must be visual or verbal communications capabilities between campers

and counselors at all times during the activity. Describe any specific duties of the activity leader, counselors and other specialty staff (if any) for this activity.

☐ None

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NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Community Environmental Health and Food Proctection

Bathing Beach Safety Plan

Name of Facility Lamoka Baptist Camp

Site Address 3646 E Lamoka Lake Rd Tyrone NY 14887

Telephone 607-280-5305 Prepared By Greg Howard Title Director Signature Date 2/5/2020

New York State Sanitary Code 6-2 requires that beach operators develop, update and implement a written safety plan. This plan must be submitted to your local health department for their review and approval. The plan must

include procedures for daily bather supervision, injury prevention, reacting to emergencies, injuries and

other incidents, providing first aid and summoning help. At ocean surf beaches, the safety plan shall be developed in consultation with an

individual having adequate ocean surf lifeguarding experience.

• Name of this individual

• Credentials Please review and complete this document. Include any attachments (i.e. photos), as necessary. Once completed, it will serve as

your facility’s comprehensive written safety plan, which will meet the requirements of the State Sanitary Code (SSC). This plan must

meet the specific conditions of your facility and operations, as well as serve as a training and reference document for you and your

staff. Local rescue, police and fire personnel should be consulted when developing your beach safety plan. Additional information may be obtained at http://www.health.ny.gov/

Please send a copy to:

And, please retain a copy of this document for your use.

FOR LHD USE ONLY Approved Yes No Reviewer Title Date

DOH-4473 (2/11) Page 1 of 27

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TABLE OF CONTENTS

Beach Characteristics . . . . . . . . . . . . . . . . . . . . . . . . ....................................... .... . . 3. �......

Bather Supervision . . . . . . . . . . . . . . . . . . . . . . . . . . ....................................... .... . . 4. �......

Supervision Level I or IIb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................................................... ...... . . . 4 �

Supervision Level III or IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................................................... ...... . . . 5 �

Certifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....................................... .... . . 17. .�.....

Injury Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . ....................................... .... .17.. �.....

Waterfront Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................................................... ...... . .18 �

Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....................................... .... . 18.. �......

Rules and Regulations . . . . . . . . . . . . . . . . . . . . . . ....................................... ..... .19. �......

Diving Areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................................................... ...... . . 19 �

Water Slides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................................................... ...... . . 19 �

Environmental Conditions and Weather . . . . . . . . . . . . . . . . . . ........................................................... ...... . .20 �

Medical Waste Contamination . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................................................... ...... . .21 �

Illness Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . ....................................... .... .22.. �.....

Fecal, Vomit and Blood Incidents . . . . . . . . . . . . . . . . . . . . . . . . . ........................................................... ...... . .22 �

Emergency Response . . . . . . . . . . . . . . . . . . . . . . . . . ....................................... .... .22.. �.....

Search Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................................................... ...... . .23 �

Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . ....................................... .... . 23.. �......

Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....................................... .... . 25.. �......

Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....................................... .... .25.. �.....

Sketch/Diagram of Beach . . . . . . . . . . . . . . . . . . . . . . ....................................... .... . 27........

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BEACH CHARACTERISTICS

Name of Facility Lamoka Baptist Camp

1 . Please indicate what your beach operation is associated with:

Homeowner association Campground Temporary residence Municipality School Other

2 . Please fill in the table below for each beach:

Length of Supervision

Regulated Level

Beach Type of Beach Beachfront Minimum Maximum Diving (I, IIb,

No. (Lake, Surf, River) (Yards) Depth (Feet) Depth (Feet) Allowed? Slides? III, IV)

1 Lake 23 1 8

Yes Yes

IIb & IV No No

2 Yes Yes

No No

3 Yes Yes

No No

4 Yes Yes

No No

5 Yes Yes

No No

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BATHER SUPERvISION

1)� The effective supervision of all bathers is essential to safety . Inadequate supervision has been determined

to be a contributing cause in over half of all drownings at regulated beaches in New York State. �

2)� A system is to be established that allows for continuous supervision and adequate visual surveillance of the

bathers . � This system will vary depending on the level of supervision required at each facility type . �

3)� Supervision Level I must be provided at all ocean surf beaches, including those associated with a temporary residence or campground .

4)� When a beach, other than surf, is part of a temporary residence or campground as defined in SSC Subparts 7-1 and

7-3, the operator must provide either Supervision Level IIb, lll, or lV aquatic supervision, as defined in SSC Subpart 6-2 .

5)� For other beaches, not associated with a temporary residence or campground, the supervision level required at

each is dependent on water depth, size of the beach area, diving boards, slides, flotation devices used, bottom

conditions and bottom slope at beaches, and surf beaches . (Please refer to SSC Sections 6-2 .17 and 6-2 .20 .)

6)� Additional supervisory staff may be required by the permit-issuing official (PIO) . Factors, including but

not limited to: beach shape, diving board use, patron decorum, patron alcohol consumption, and bathing

facilities used primarily for the developmentally disabled may be the basis for increased coverage .

7)Homeowner beaches are exempt from Subpart 6-2, Bathing Beaches, except: – An ocean surf beach is not exempt; – � If a homeowner beach is used by people other than the owner/residents, their friends, renters or guests, then the operator must

comply with applicable regulations during those periods of use . (Please refer to SSC Section 6-2 .17(a)(2) .)

Is your beach part of a homeowner association and an ocean surf beach? Yes No

Is your beach part of a homeowner association that allows outside groups to use it? Yes No

If “yes” to either question above, please continue.

Supervision I or IIb

Supervision Level I – Surf Lifeguard

17. � Is required at all ocean surf beaches, including those associated with a homeowner association and a temporary residence or campground .

Supervision Level IIb – Beach Lifeguard

• � Unless associated with a temporary residence or campground, Supervision Level IIb is required when any of the following

are present: water depth within the designated bathing area is five feet or greater; diving boards; flotation devices other

than U .S . Coast Guard Type I-III; bottom conditions hazardous to bathers; aquatic amusements; bathing area perimeter is 50 feet or more from shore; beach bottom slope is steeper than 1:8; slides that discharge into the water .

Do you provide Supervision Level I at your facility? Yes No

If “yes,” please continue with questions 3-22 and 33-64.

Do you provide Supervision Level IIb at your facility? Yes No

If “yes,” please continue with questions 9-22 and 33-64.

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Supervision Level III or Iv

• Are supervisory staff, provided by the facility, who possess certain skills and requirements per SSC Section 6-2 .20 .

• May be selected when the bathing facility is part of a temporary residence or campground .

• If part of a temporary residence or campground, when Supervision Level III or IV is selected, on-premise CPR is not required .

• If a temporary residence or campground operator allows persons other than registered overnight

patrons and their guests to use the beach, then the operator must provide a leveI of supervision during

that period of use which is consistent with the beach characteristics . (Please refer to Subpart 6-2 .17(2) .) – Beaches with water depth 5 feet or more, diving boards, water slides, flotation devices (other than U .S . Coast Guard Type

I–III Label), bottom conditions hazardous to bathers, aquatic amusements, bathing area perimeter is 50 feet or more from

shore, or beach bottom slope is steeper than1:8 must provide Supervision Level II, a lifeguard . – When a beach otherwise qualifies for Supervision Level IV, on-premise CPR certified staff are required .

Supervision Level Iv

• Supervision Level IV may be selected if the water depth within the designated bathing area is less

than five feet and the bathing area perimeter is less than 50 feet from shore .

• At Supervision Level IV, the aquatic staff shall be on premises at all times the beach is in use with

periodic visual checks of the waterfront conducted and logged .

Do you provide Supervision Level III at your facility? Yes No

If “yes,” please continue with questions 23 and 33-64.

Do you provide Supervision Level IV at your facility? Yes No

If “yes,” please continue with questions 23-64.

Supervision I

• All ocean surf beaches, including those owned and operated by homeowner associations, are required to have at least one

Supervision Level I aquatic supervisory staff who is trained and certified in the operation and use of an automated external

defibrillator (AED) approved by a nationally recognized organization or the state emergency medical services council .

• This certified Supervision Level I staff must be present and available at all times the beach is open for use .

• The training and certification records must be available for review during inspections .

3 . How many Supervision Level I staff do you have who are certified in using AEDs? Number of staff All staff are trained and certified in the use of AEDs

4 . Is at least one Supervision Level I staff who is certified in using AEDs on-site and

available at all times when the beach is open for use? Yes

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Emergency Equipment – AED

• � At ocean surf beaches, at least one AED must be provided by the operator and maintained on-site .

• � The beach operator must implement a Public Access Defibrillator (PAD) program as defined in 6-2 .2(i) of Subpart 6-2 .

• � The following must be maintained and available on-site for review during inspections: – � A copy of the collaborative agreement between an emergency health care provider and the ocean surf beach operator; – � A copy of the notification to the Regional Emergency Medical Services Council (REMSCO) of the existence, location, and type of automated external defibrillator;

– � The records of AED maintenance and testing specified by the manufacturer’s standards .

5 . How many AEDs do you have on-site? None

6 . Where are the AEDs located?

At lifeguard chairs At the first aid station �

Other (Specify) �

7 . � Indicate the procedure used to summon the AED certified staff and the AED to an emergency:

All lifeguards are certified in AED use and have one with them at

their station Other

8 . What is the emergency response time for getting the AED and AED certified staff to the emergency site?

Within 1 minute 1-3 minutes �

Other (Specify) �

Please attach a copy of the signed Collaborative Agreement with the appropriate Regional

Emergency Medical Services Council (REMSCO) as defined in the PAD program requirements.

Yes, I have attached the above .

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Supervision I or IIb

When developing your supervision and surveillance system for your facility, many factors must be considered to ensure total

visual coverage of the bathing area and that the lifeguards are able to perform their duties when bather density is high:

• Number of lifeguards necessary – SSC requires one lifeguard for each 50 yards of beach or fraction thereof. 6-2.17(a)(4) – Additional lifeguards may be necessary depending on the beach shape, diving board use, patron decorum,

patron alcohol consumption, and usage by developmentally disabled patrons . 6-2.17(a)(5). – Bathers tend to congregate in shallow water areas . – Consider peak uses such as exceptionally warm weather, holidays, etc . – Swim classes or use of the facility by outside groups may necessitate additional staff . – There should be enough lifeguards to provide coverage during breaks or when other lifeguards take days off .

• Supervising Lifeguards – When a beach is required to provide three or more aquatic staff, a supervising lifeguard is required. 6-2.17(a)(8) – The supervising lifeguard must oversee and manage lifeguards to ensure proper positioning, zones of

coverage and that in-service training/drills are performed .

• Positioning – A minimum of one lifeguard chair is required for each 50 yards of supervised beach or as

specified in this plan, as approved. 6-2.17(b)(3) – Where swimming or diving is permitted more than 150 feet from shore, lifesaving patrol boats or

offshore lifesaving stations must be provided. 6-2.17(b)(3) – Elevated lifeguard chairs, equipped with an umbrella or shade, are required at all beaches which provide

Supervision Level I or IIb . – Chairs must be located to compensate for glare and blind spots, and in positions which provide

complete surveillance coverage of the beach area . – Lifeguards must have designated areas of responsibility and be able to have total visual surveillance of that swim area . – Consider bather densities and locations, which may require additional lifeguards and various positioning schemes .

• Rotations – Proper chair rotation procedures must be followed to ensure no interruption in surveillance. – Rotating lifeguards must maintain constant surveillance of the area of responsibility and not be distracted

during a chair rotation .

• Breaks – Lifeguards should take frequent breaks to avoid fatigue, but there must be enough coverage

during these times or the beach must be closed and posted as such.

• Please refer to SSC Section 6-2 .17 .

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Number of Lifeguards

9 . � How many lifeguards will you use to properly supervise your bathing facilities? (Please list all your beaches with the number of lifeguards for each below .)

Bathing Beach Length of Beach Number of Number of Elevated

Beach No. (Name and Type) (Feet) Lifeguards Lifeguard Chairs

1 Waterfront 70 2-3 3

2

3

4

5

10 . Will you use additional lifeguards at any time during your season? Yes No

(If “Yes,” please complete a . and b .)

a .

Beach No.

Number of Lifeguards

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

1

2

3

4

5

b . Please explain why/when you will use additional lifeguards:

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Supervising Lifeguards

Supervising Lifeguards are required:

• When the facility is required to provide three or more aquatic staff;

• If employing a 15 year old lifeguard .

The supervising lifeguard must be on-site, in the beach area, to oversee and manage lifeguards.

11 . Is your beach required to have a supervising lifeguard? Yes No

(If “Yes,” please complete a .)

a . Indicate the duties of your supervising lifeguard:

Supervise the lifeguard staff Scheduling of lifeguards to ensure adequate coverage Ensure implementation of lifeguarding policies and procedures Coordinate in-service training/drills of lifesaving skills and emergency response

procedures Other (List):

1 . 2 . 3 . 4 .

Glare and poor water clarity are key contributing factors in many drownings.

Lifeguard Positioning

12 . What is the distance between the elevated lifeguard chairs?

Less than or equal to 50 yards Greater than 50 yards (Specify) yards

a . If greater than 50 yards, please explain your rationale for this . (Indicate the response time for the

lifeguard from the chair to the furthest point within his/her surveillance area .)

13 . How will staff compensate for glare and blind spots and obtain complete visual coverage? (Check all that apply .) Not a problem at my beach Use in-water positions (i .e . on raft) Move lifeguard chairs

Other (Specify) Sunglasses and umbrellas when nessisary

14 . Do you provide lifesaving patrol boats/boards or offshore lifesaving stations? Yes No

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Lifeguard Rotations

• � NYS drowning data indicates that many drowning incidents have occurred directly

before, during, and directly after a chair rotation because the lifeguards were distracted

and did not provide constant patron surveillance during the rotation procedure. �

• � During that period when lifeguards rotate their chair positions, if proper chair rotation procedures are not followed, a lifeguard can be temporarily distracted . �

• � Lifeguard rotations should take place on a regular schedule and should follow a defined pattern .

• � Continuous coverage must be provided when changing or rotating lifeguards .

• � Additionally, periodic rotations to different stations helps keep lifeguards alert .

15 . Do you use multiple lifeguards at your beach? Yes No

(If “Yes,” please complete a ., b . and c .)

a . �Do you have an established chair rotation procedure? Yes

b . Does your chair rotation procedure ensure that there is continuous lifeguard surveillance of patrons

during the change? Yes

c . �How frequently do your lifeguards rotate? �

Every 30 minutes � Every 60 minutes �

Other (Specify) �Every 30-45 minutes

Lifeguard Breaks

• � Failure to take breaks has been identified as a contributing factor in drownings in NYS.

• � Lifeguards need to take frequent breaks to avoid mental and physical fatigue .

• � Research indicates that lifeguard attentiveness declines after 30 minutes .

• � Scheduled breaks and rotating to different stations can keep lifeguards alert and ready to respond .

• � If another lifeguard is not available to cover during breaks, (at single guard facilities), the beach must be closed during the breaks . �

16 . How frequently do your lifeguards take breaks (include lunch)?

Every 30 minutes Every 60 minutes �

Other (Specify) �Evert 30-45 minutes 17 . What is your protocol for bather supervision during lifeguard breaks or when a lifeguard takes the day off?

Use other lifeguards to cover Close the beach/sections (Please answer a . and b .)

a . Who is responsible for clearing and closing the beach during these breaks? �

Lifeguard � Maintenance staff Facility operator �

Other (Specify) �

b . Who assures that no one enters the water while the beach is closed? �

Lifeguard � Maintenance staff Facility operator �

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Distractions �

• Lifeguard distractions and intrusions have been identified as contributing factors in drownings.

• � Distractions occur when lifeguards engage in activities such as using cell phones, reading or having lengthy conversations with patrons or others . �

• � Many lifeguards are assigned additional duties at a bathing facility . These duties must

not intrude upon the lifeguard’s primary responsibility of guarding . �

18 . Are your lifeguards assigned any additional duties at your facility? Yes No �

Please list other duties below: �

a . Cleaning and maintaining the beach area

b . c . d . e .

19 . Will you restrict the lifeguards from performing these other duties while guarding? Yes N/A

Use of Beach by Outside Groups

• � If you allow outside groups to use your beach and they use their own lifeguard, there must be a plan for

coordination of supervision, emergency response procedures and water quality issues during these times . �

20 . Do you allow outside groups who provide their own lifeguard to use your beach? Yes No

(If “Yes,” please complete a .-f .)

a . Is the outside group’s lifeguard familiar with your safety plan and emergency procedures? Yes

b . Is the emergency telephone and safety and first aid equipment available for use during these periods? Yes

c . �Who is responsible for activating the emergency response plan, if needed? �

Outside group’s lifeguard �

Other (Specify) �

d . What is the availability of this person (indicated in c . above)? �

On-site � On-call �

Other (Specify) � e . Who is responsible for addressing water quality issues at your beach during the time an outside group is using the beach?

Maintenance staff Facility operator �

Other (Specify) �

f . What is the availability of this person (indicated in e . above)?

On-site On-call �

Other (Specify) �

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Use of Pool by Developmentally Disabled (DD) Groups �

• � Groups of developmentally disabled (DD) patrons may require additional assistance and supervision .

• � Disabilities can include a loss, absence, or impairment of sensory, mental or motor function .

• � Patrons with impaired motor function may have difficulty navigating at a beach . Those with hearing, vision, or mental

function impairments may not be able to hear, read or understand directions provided verbally or in signs . �

• � Emergency response may need to include both auditory and visual signals and care and evacuation of patrons with disabilities may require additional assistance . �

• � Additional supervisory staff, including lifeguards and others, may be needed to assist groups of DD patrons .

• � If an outside group of DD patrons uses the bathing facility, the operator must ensure that

adequate supervision and emergency response is in place . �

• � An analysis of the NYSDOH’s investigation of 10 drowning incidents of DD patrons revealed several common factors.

• � In response to these factors, additional recommendations were developed for the staff responsible for the care

of DD individuals. �

• � The operator of a bathing beach should coordinate with the DD group’s staff to ensure that the following guidance is addressed:

– � DD staff responsibilities should be clear .

– � Those responsible for providing supervision must be at the waterfront directly supervising patrons .

– � DD staff must not be distracted by conversations or other activities that interfere with their responsibility of supervising the patrons assigned to them .

– � DD staff to patron assignments should be specific .

– � DD staff to patron ratio should be consistent with level of disability .

– � One on one supervision should be provided for patrons with seizure disorders, with the DD staff person in the water providing direct supervision of that patron .

– � Non-swimmers should be restricted to water depths no greater than chest deep with a process for implementing this developed and which may include positioning of DD staff in the water .

– � Personal flotation devices (PFDs) must be properly sized and fitted to be effective; however, they are not a substitute for close supervision . PFDs can be removed, rendering them ineffective and potentially leaving the consumer in water deeper than is appropriate for their height or abilities . – � Patron supervision should not be interrupted by DD staff performing other duties, such as escorting patrons to the restroom .

21 . Do groups of DD patrons use your beach? Yes No

(If “Yes,” please complete a . and b .)

a . �Does the DD group provide additional supervision of these patrons as specified above? Yes No �

(If “No,” explain how adequate supervision is provided .) �

b . How do you ensure that there is adequate supervision for DD patrons?

Written agreement with the group’s organization/responsible staff

Other (Specify)

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Instructional Activities �

• � Investigations of drownings that occurred during instructional activities, such as learn to swim programs,

physical education classes, and swim team activities, have determined that if the lifeguard is performing

instructional activities, it distracts from lifeguarding duties and has been a contributing factor in drownings .

• � As a result, when the lifeguard is providing instruction, a second person must be provided for bather supervision:

– � Another Supervision Level IIb (lifeguard dedicated to guarding only); or

– � A Supervision Level III (responsible person)

• � At least one additional qualified staff must be provided for each required lifeguard engaging in instructional activities .

22 . Is your bathing facility used for instructional activities, such as learn to swim programs, physical education classes (open

and instructional classes), and swim team activities (practices and meets)? (If “Yes,” please complete a .) Yes No

a . �Who is the second person used for bather supervision? (If you use a Level III staff, please complete 1), 2), 3), 4) .) �

Lifeguard � Level III staff �

• Please list the duties of the Level III supervisory staff? (Please list below .) �

• �

• �

• �

• �

• Does the Level III staff work under the direction of the lifeguard, providing additional surveillance, to ensure adequate bather supervision and emergency response? � Yes �

3) If the Level III staff notes an aquatic emergency, how does he/she communicate this to the lifeguard? �

4) Please provide a sketch below to show the positioning of the Level III and Level IIb Supervision staff .

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Supervision III or Iv

Supervision Level III

• � Can be chosen by the operator if the beach is associated with a temporary residence or campground .

Supervision Level Iv

• � Is allowed if the water depth within the designated bathing area is less than five feet and the bathing area perimeter is less than 50 feet from the shore; �

• Can be chosen by the operator if the beach is associated with a temporary residence or campground .

– � When the physical characteristics of the beach allows for Supervision Level Iv, on-premise

CPR certified CPR staff are required.

• � If the bathing facility is part of a temporary residence or campground, when Supervision Level III or

IV is selected, the operator shall not allow the use of this bathing facility by persons other than

registered overnight patrons of the temporary residence or campground and their guests .

• � If the facility allows persons other than registered overnight patrons and their guests to use the beach, then the operator must

provide the level of supervision appropriate for the physical characteristics of the beach . (Please refer to Subpart 6-2 .17(a)(2) .)

– � Supervision Level IIb is required when any of the following are present: water depth within the designated bathing

area is five feet or greater; diving boards; flotation devices other than US Coast Guard Type I-III; bottom conditions

hazardous to bathers; aquatic amusements; bathing area perimeter is 50 feet or more from shore; beach bottom slope

is steeper than 1:8; slides that discharge into the water .

– � Supervision Level IV is allowed when the water depth within the designated bathing area is less than five feet and the bathing area perimeter is less than 50 feet from the shore .

• When a beach otherwise qualifies for Supervision Level IV, on-premise CPR certified staff are required .

23 . Is your bathing facility part of a temporary residence or campground? Yes No

(If “Yes,” please complete a . and b .)

a . Do you allow persons other than registered overnight patrons to use your beach? Yes No �

(If “Yes,” you are required to provide Supervision Level IIb or IV, based on the physical characteristics,

during the times the beach is used by the outside groups . Please complete the appropriate questions .) �

b . �If you provide Level III at your facility, who is the Supervision Level III staff who provides direct supervision at the beachfront during the times the beach is in use?

N/A Owner/operator Facility manager �

Other (Specify) �On duty lifegaurds

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Supervision Iv

24 . Is your facility required to provide on-premise CPR staff? Yes No (If “Yes,” please complete a ., b . and c .)

a . Who is the on-premise CPR certified staff?

Owner/operator Facility manager

Other (Specify) This is either the facilities manager or a designated lifegaurd or designated CPR certified adult.

b . How is this person summoned to the emergency?

This person is always within hearing distance of the beach area

By telephone Cell phone that the person carries at all

times Other (Specify) c . What is the emergency response time for this person to the beach area?

Within 1 minute 1-3 minutes Other (Specify)

A drowning victim has the greatest chance of survival if CPR is initiated immediately.

➢ If a drowning victim is rescued and effective ventilation and circulation is restored within 0-3 minutes of submersion, the victim has an excellent chance of normal survival .

➢ The longer the time period, the more probable it is that permanent neurological damage or death will occur .

Please refer to the Emergency Response section Pages 22-26 for additional information .

Daily Monitoring

• Supervision Level Iv includes a combination of daily monitoring, posting required warning signs, providing

patrons with the required rules in writing, enforcing all rules, providing conveniently located emergency

communication and providing required safety equipment . To be in compliance with Supervision Level IV

requirements, all of these components must be in place . (Please refer to SSC Section 6-2 .17(a)(10) .)

25 . Who is the Supervision Level IV staff who performs visual checks and is on the premises during the time the beach is in use?

Owner/operator Facility manager Other (Specify) Or a lifeguard when on duty or available.

26 . How often does the Level IV staff monitor the beach throughout the day?

1-2 times/day 2-5 times/day More than 5 times/day

Other (Specify)

27 . Who monitors to see that the rules are being followed?

Owner/operator Maintenance staff Facility manager Other (Specify) Or a lifeguard when on duty or available.

28 . Who is responsible for performing the daily compliance check (including safety equipment, water conditions, and hazard checks) prior to the beach opening each day?

Owner/operator Maintenance staff Facility manager Other (Specify) Or a lifeguard when on duty or available.

29 . Who maintains the daily log?

Owner/operator Maintenance staff Facility manager Other (Specify) This is either the facilities manager or the on duty lifegaurd

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Rules and Regulations

Supervision Level Iv facilities must post specific beach rules which state:

• Two or more adults (18 years or older) must be present at the beach when beach is in use, with at

least one adult on the beachfront .

• Children less than 16 years must at all times be accompanied by a parent or guardian or similar adult

responsible for their safety and behavior while at the bathing facility .

• Swim only within the designated bathing area .

• Method of summoning on-premise CPR staff (only where CPR trained staff is required .)

• Location of free telephone and emergency numbers

Required Sign

30 . Where is the required sign located?

Beachfront

Other (Specify)

Required Notification of Patrons

• Patrons must be provided with a written statement or brochure before they use the bathing facility .

(Please refer to SSC Section 6-2 .17(a)(10)(vii) .)

• It is recommended that patrons be provided this information at the front desk at the time of check-in

or at the time a lease agreement is signed with periodic reminder notices .

• In drowning investigations at Supervision Level Iv facilities, failing to provide patrons

with the written statement or brochure has been documented in many of the incidents.

31 . Is a written statement or brochure indicating the required rules provided to all patrons? Yes No

32 . How and when is this information provided? (Check all that apply .)

At the front desk at the time of check-in

Patrons must sign saying they have received it

At the time of the lease agreement

Tenants must sign saying they have received it

Periodic notifications are provided to tenants (Specify how and frequency)

Other (Specify)

Please enclose a copy of this brochure.

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CERTIFICATIONS – SUPERvISION I, IIb, III, Iv

• � It is the responsibility of the facility owner/operator to make sure that the supervisory aquatic staff they hire

have the proper skills and certifications . Copies of these certifications must be maintained on-site and be

available for inspection by DOH staff . (Please contact your LHD for a list of acceptable courses.)

• � Please refer to SSC Sections 6-2 .20 for aquatic supervisory skill requirements .

INjURY PREvENTION

The most important responsibility of a bathing facility operator and supervisory staff is the prevention of

injuries at the facility. There should be an on-going comprehensive safety program at your facility.

voluntary Hyperventilating and Extended Breath Holding

• � The practice of voluntarily hyperventilating (taking a series of deep breaths in rapid succession and forcefully exhaling)

followed by underwater swimming or holding one’s breath for extended periods of time is dangerous and has led

to deaths.

– � When you hyperventilate, you lower the percentage of carbon dioxide in the air that always remains in your lungs .

– � The carbon dioxide in the bloodstream is what triggers that part of the brain that controls breathing to initiate

taking a breath . �

– � By decreasing the available carbon dioxide, you can remain underwater because you delay the point at which the brain signals the need to take a breath .

– � When the oxygen level in the blood runs low before the carbon dioxide level rises to the point that

triggers the breathing reflex, the swimmer loses consciousness .

– � The swimmer never actually feels as though a breath is needed .

Shallow Water Blackout

– � Swimmers who practice prolonged underwater breath-holding are at risk for Shallow Water Blackout (SWB) .

– � SWB results from an insufficient amount of carbon dioxide to activate the body’s natural impulse to breathe .

• � victims of hyperventilation and SWB are often skilled swimmers.

• � victims can also be children and others who participate in ‘hold your breath’ games.

• � Lifeguards and other supervisory staff should be alert for this safety hazard and should discourage this behavior.

• � Operators should consider posting a sign explaining this hazard and prohibiting it at their beach.

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Waterfront Hazards

Identify potentially hazardous areas such as underwater slopes, holes, currents, stumps, rocks, diving boards, slides, etc . Such areas should be eliminated, marked to help patrons avoid the areas, or additional supervision provided for these areas .

33 . Are there any potentially hazardous areas at your beach?

Underwater slopes Stumps/rocks Holes Diving boards Currents Slides

Other (Specify) 34 . What are your plans for controlling or eliminating the hazards associated with these areas? (Please

specify hazards and how you will eliminate or control, ex . Rock-Remove from swim area .)

Eliminate Hazard(s) Specify how

Mark Hazard(s) Specify how

Supervise Hazard(s) Specify how

Other Hazard(s) Specify how During level IV we either do not allow them to use the slide or we move up to level IIb

35 . Who is responsible for addressing the hazards listed above?

Owner/Operator Maintenance staff Facility manager Lifeguard Other (Specify) Lifegaurds or counselors for lvl IIb and we do not allow them to use it if under IV

Maintenance

Daily inspections of the beach area are necessary to assure that adequate safety levels are maintained . Any problems,

such as unsafe water conditions, broken equipment, loose ladders, etc . are to be reported and immediately corrected . If

the problem cannot be immediately corrected, the specific area or entire beach should be closed, as appropriate .

36 . Who is responsible for performing the daily compliance check (including safety equipment, water

conditions, and hazard checks) prior to the beach opening each day?

Owner/operator Maintenance staff Facility manager Lifeguard

Other (Specify)

37 . To whom will maintenance issues and unsafe conditions be reported?

Owner/operator Maintenance staff Facility manager Lifeguard

Other (Specify)

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Rules and Regulations

1) Operators must post signs stating the hours during which the beach is open and that swimming at other times is prohibited .

2) Signs stating general rules must be posted conspicuously at the beach, dressing rooms and facility offices . These

rules should prohibit urination, discharge of fecal matter, spitting and nose blowing, as well as govern the use of

diving boards and slides . These rules may also include prohibitions against running, horseplay, use of alcohol, etc .

38 . Where are your rules posted?

Waterfront Bathhouse

Other (Specify)

39 . Who is responsible for enforcing the rules at your bathing facility?

Owner/operator Maintenance staff Facility manager Lifeguard Other (Specify) Lifeguards, Facility Manager, and Counselors

40 . Who is responsible for preventing boaters from entering the swim area?

Owner/operator Maintenance staff Facility manager Lifeguard Other (Specify) Lifegaurds and Facility Manager

Diving Areas

• Diving areas require extra attention due to the potential for serious injury . Rules for the use of diving equipment should be developed, posted at the diving area and enforced .

• Diving from a raft, pier, or other platform is permitted in water at least 8 feet deep and extending out for at least 10 feet . (Refer to SSC Section 6-2 .19 item 4 .8 .)

• Warning signs stating “No Diving” must be clearly posted in areas (docks, rafts, etc .) where diving is not allowed .

• Most spinal cord injuries associated with diving incidents occur in the natural environment (lakes, rivers, etc.) and,

• Most occur in water depths less than 6 feet.

41 . Do you allow diving at your bathing facility? Yes No

a . If no, are warning signs stating “No Diving” clearly posted? Yes

b . Where are the diving rules clearly posted? On the docks.

c . Who enforces these rules?

Owner/operator Maintenance staff Facility manager Lifeguard

Other (Specify)

Water Slides

• Improper use of slides can result in serious injuries similar to those for diving boards .

• Sliding should be performed only in the sitting position facing forward .

• Rules for use of slides should be developed, posted at the slide and enforced .

42 . Do you have slides at your beach? Yes No a . If yes, where are the rules clearly posted? At the ladder of the slide. DOH-4473 (2/11) Page 19 of 27

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Environmental Conditions and Weather

• Environmental conditions must be constantly evaluated at all beaches . Conditions which may require that the

beach be cleared of bathers include: unsanitary water conditions, high turbidity, glare, thunderstorms, heavy

rains or hailstorms, fog resulting in reduced visibility, heavy or high wave action, and dangerous currents .

• Each facility should have procedures in place for clearing the water when necessary . These procedures should

include who is responsible for monitoring beach closure and what type of communication system will be used .

Lightning Tips

• The National Lightning Safety Institute recommends that bathing facilities monitor storm activities,

suspend swimming activities when lightning is within 6-8 miles and wait until 30 minutes after

lightning has been observed before resuming water activities .

• Designate a responsible person as the weather safety lookout . That person should keep an eye on the weather . Use a

“weather radio” or the Weather Channel or other TV program to obtain good localized advanced weather information .

• When thunder and/or lightning are first noticed, use the Flash-To-Bang (F-B) method to determine its rough distance

and speed . This technique measures the time from seeing lightning to hearing associated thunder . For each five

seconds from F-B, lightning is one mile away . Thus, a F-B of 10 = 2 miles; 15 = 3 miles; 20 = 4 miles; etc . At a F-B

count of thirty, the beach should be evacuated . People should be directed to safe shelter nearby .

• Swimming activities should remain suspended until thirty minutes after thunder or lightning were last observed .

43 . When unsafe conditions occur, who is responsible for monitoring beach closure at your facility?

Owner/operator Maintenance staff Facility manager Lifeguard

Other (Specify)

44 . When will you close the beach for thunderstorms?

At the first sign of thunder or lightning Other (Specify)

45 . What communication system is used for clearing the beach?

Whistle (Specify signal) Long blast followed by vocal instruction. Bullhorn (Specify signal) Voice (Specify) Other (Specify)

46 . When will you allow re-entry into the water?

After at least 30 minutes without any thunder or lightning Other (Specify)

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Medical Waste Contamination

Presence of Medical Waste at Beaches

• Medical debris consisting of blood vials, syringes, needles, medical or surgical gloves and other

discarded medical supplies are sometimes found on beaches .

• Operators of beaches which have the potential for medical waste to wash up must have procedures

in place for addressing this type of incident .

47 . Is your beach at risk for medical waste contamination? Yes No

(If “Yes,” please complete a .-f . Check all that apply for each question .)

a . Who is responsible for identifying medical waste at your beach?

Owner/operator Maintenance staff Facility manager Lifeguard Other

(Specify)

b . Who is the initial responder to this type of incident?

Owner/operator Maintenance staff Facility manager Lifeguard

Other (Specify)

c . Who is responsible for handling, storing and disposing of medical waste?

Owner/operator Maintenance staff Facility manager Lifeguard

Other (Specify)

d . Who is responsible for notifying the local health department?

Owner/operator Maintenance staff Facility manager Lifeguard

Other (Specify)

e . Who is responsible for monitoring the affected beach area?

Owner/operator Maintenance staff Facility manager Lifeguard

Other (Specify)

f . What is your procedure for addressing medical waste contamination?

Close beach .

If small amounts of medical waste are found on the beach only, do not close beach .

If larger amounts of medical waste are found on the beach only, affected portion of the beach is closed .

If large amounts of medical waste are found on the beach and/or floating in the water, close the

entire beach . Other (Specify)

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Illness Prevention

Fecal, vomit and Blood Contamination Incidents

• � Fecal, vomit and blood incidents which occur at beaches pose a potential risk of infection to

bathers . Feces, vomit and blood may contain pathogenic or harmful bacteria, viruses and

parasites, with diarrheal accidents being more indicative of an illness .

• � Since disinfectants cannot be added to natural bodies of water, it is recommended that there be prompt removal of the stool or vomit . Dilution and circulation factors should be considered for the area, which is dependent

on beach shape, wind, currents, etc ., prior to reopening the beach .

EMERGENCY RESPONSE

• � An effective prevention program will greatly reduce the occurrence of injuries . Any delay in

response may increase the degree of injury or lead to death . A written procedure responsive to

potential incidents or emergency situations must be developed and practiced .

• � An emergency should be considered as any situation that jeopardizes the health and safety of a patron or diverts the supervisor’s attention from general supervision of bathers .

• � The facility name and street or 911 number should be clearly posted for emergency personnel to easily identify the address .

• � Local rescue, fire and police personnel should be consulted when developing an emergency response plan .

Seizures

• � Any person who suffers a seizure in the water and submerges should be transported to a medical facility regardless of apparent recovery .

• � They should not be allowed back in the water for the rest of the day .

Emergency response procedures must include:

• � Clearing the waterfront area

• � Emergency care of the victim

• � Contacting emergency personnel

• � Crowd control

• � Meeting and guiding emergency personnel to the site and/or victim

• � Directing traffic

• � Drills for emergency response situations

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Search Procedures

• Time can be critical when searching for a lost bather . Lifeguards are trained in proper search methods and these can vary

depending on the facility characteristics . Specific water search procedures should be established . Obtain a description of the

missing individual and last location seen . A simultaneous land and water search should be initiated immediately .

48 . Who is responsible for performing a lost bather search at your facility? (Please answer a or b or both, if applicable .)

a . Supervision Level I or IIb Facilities

Lifeguard Other (Specify)

1) Is there an established search procedure for the lifeguards? Yes No

2) How often do the lifeguards practice the search procedures and other emergency response drills? Once a week Other (Specify) First week of camp and the week before camp.

• Providing snorkel, masks and fins to the lifeguard(s) could assist in deep water rescues .

b . Supervision Level III or Iv Facilities

Owner/operator Maintenance staff Facility manager Other (Specify) Any staff on duty and on campus will be used to help with search.

49 . Describe your lost bather search procedure . During lvl IIb: when a buddy check fails to account for person or if missing camper is suspected: the area and water will be

cleared, the director and aquatics director will be notified, information will be gathered, lifegaurds will begin deep water dives and designated staff will search the area and conduct leg sweeps, campers will be moved and supervised by counselors. During lvl IV Owner will be notified, staff will make a visual search and conduct leg sweeps in the water.

Communication

• Communication is essential during an emergency . A chain of command should be developed as part of an

emergency response plan . A phone or other acceptable means of communication must be provided at a

convenient location at all waterfronts . All staff should know the location of the nearest telephone . Emergency

phone numbers must be prominently posted at the telephone(s) . A method of communication between staff

such as whistles or hand signals should be established and staff should be familiar with it .

50 . Is there a chain of command established for your facility during an emergency? Yes

51 . Is a telephone or other means of communication readily accessible at the waterfront? Yes

Describe other

52 . Where is the emergency phone with emergency numbers located?

Beachfront Bathhouse Facility office Other (Specify) Nurse Office

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In a near-drowning emergency, the sooner the rescue and first aid begins, the greater the victim’s chance of survival.

• � If a drowning victim is rescued and effective ventilation and circulation is restored within

0-3 minutes of submersion, the victim has an excellent chance of normal survival. �

• � Within 3-5 minutes, survival may be likely, but the more probable it is that permanent neurological damage will occur.

• � 5 minutes or more, normal recovery is uncommon unless the water temperature is below 70°F.

53 . How far is the emergency phone from the waterfront?

At beachfront 5-50 feet 51-100 feet 100-200 feet More than 200 feet �

Other (Specify) �

54 . Please indicate the emergency numbers 911

55 . Where is the first aid room or first aid kit located?

Beachfront Bathhouse Facility office �

Other (Specify) �A more extensive room is located in nurse station

• � Usually a large number of people congregate at the scene of an emergency . The emergency plan

must include crowd control and on-going supervision of the facility . Access for emergency personnel

should be evaluated with an access route pre-determined . During an emergency it is extremely

important to provide rescue personnel with detailed directions to your bathing facility .

56 . Who is responsible for performing crowd control duties in the event of an emergency at the waterfront?

Owner/operator Maintenance staff Facility manager Lifeguard �

Other (Specify) �Counselors and lifegaurds, during lvl LV, on site adults/parents.

57 . What is your planned route to be used for emergency response and evacuation at your facility? Our beach is located right next to a road. This road can be used by emergency response personnel. Evacuation can also happen on or across this road.

58 . Who is responsible for meeting the emergency vehicle and directing it to the site?

Owner/operator Maintenance staff Facility manager Lifeguard �

Other (Specify) �Staff will be used to direct the vehicle.This will be overseen by the Owner/operator.

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Reporting

• The operator must keep daily records which indicate the number of bathers, number of lifeguards on

duty, weather conditions, water clarity, water quality, any reported rescues, injuries and illnesses .

These records must be available for review by the Permit Issuing Official for at least 12 months .

59 . Who is responsible at your facility for maintaining the required daily records, including the injury/illness log?

Owner/operator Maintenance staff Facility manager Lifeguard

Other (Specify)

• It is the responsibility of the facility operator to report all incidents occurring at his or her bathing

facility to the Permit Issuing Official (PIO) as soon as possible, but within 24 hours . Reportable

incidents include those which result in death, require resuscitation, require referral to a hospital or

other facility for medical attention or is a bather illness associated with bathing water quality .

Local Health Department Number 607-324-8371

60 . Who is responsible at your facility for reporting any of the above to the PIO?

Owner/operator Maintenance staff Facility manager Lifeguard Other (Specify) Camp nurse and/or owner/operator

Training

• All staff involved in emergency response must be trained . Frequent trainings to reinforce the

principles and rehearse the plan must be conducted .

• Supervisory staff must also practice their lifesaving skills regularly to remain proficient and able

to perform rescues when required .

61 . How often do staff practice the emergency response drills?

Once a week Twice per month Other (Specify) During lvl IV times, the owner/operator will review plan and be prepared to enact it.

62 . Who is responsible for conducting these trainings?

Owner/operator Maintenance staff Facility manager Lifeguard Other (Specify) Assistant Director or designee

63 . Who participates in this training? (Please list job titles .)

a . During IIb: Program Coordinator, All Staff, All Campers (during camper weeks)

b . During lvl IV: Leg sweep training will happen at the begining of each season with personell.

c. d . e . f .

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If you do not have an Ocean Surf Beach, yet provide AEDs at your beach:

• � Please attach a copy of the signed Collaborative Agreement with the appropriate Regional Emergency Medical Services Council (REMSCO) as defined in the PAD program requirements .

• � Please indicate any attachments with this document: � AED Collaborative Agreement � Staff certifications/credentials � Facility sketch � Additional emergency procedures � Level IV patron notification statement/brochure � Other (Specify) �

• � Please indicate the number of additional pages attached .

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SkETCH/DIAGRAM OF BEACH

64 . Sketch below or attach a diagram or photograph(s) of the beach area(s) . Sketch must include:

• � If you provide lifeguards, show the location of lifeguard positions and areas of lifeguard coverage for

each position . Include the distances between lifeguards and indicate how you adjust for factors which

could affect adequate supervision and coverage, such as glare, blind spots, bather load and density . • � If you use a Level III aquatic supervisory staff, please show the location for this person(s) position . • � Areas of responsibility for patron surveillance • � Float line placement • � Diving boards, slides and rafts • � Access points and sign locations • � First aid stations, emergency/lifesaving equipment (including AEDs) and telephone locations • � Lifesaving boat placement, etc .

Please attach additional pages, if necessary.

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Activity Plan

Camp Name: Lamoka Baptist Camp Date: 6/19/2018

Prepared By: Greg Howard Title: Director/Administrator

Phone number: 607-463-0324 Email Address: camp@lamoka.com

Signature: Greg Howard

For Health Department Use Only

Approved: ☐ Yes ☐ No Reviewer: Date: Comments:

Complete the following plan for each activity without an Activity-Specific Plan or that requires additional supervision or safety procedures from what has been provided in Section V (Supervision and Activity Safety) of the main document (e.g. requires additional/specialized staff, minimum participant prerequisites, safety equipment). Activities that have similar safety and supervision procedures may be listed on the same worksheet. Submit the completed plan to the local health department or State District Office that has jurisdiction in the county where the camp is located for review. A copy of the approved plan must be maintained at the camp and reviewed by the activity leader prior to overseeing the activity.

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ACTIVITY: Arts and Crafts SUPERVISION

• Each activity at camp must be supervised by an activity leader that is competent in the activity being conducted. Activity leaders of an activity that includes wilderness hiking, camping, rock climbing, horseback riding, bicycling, swimming and/or boating must be at least 18 years of age.

• A minimum of one activity leader and one staff member must supervise activities that occur at locations where additional camp staff assistance is not readily available (within five minutes).

• When the activity is conducted at a location where the camp staff certified in first aid and CPR are not readily available, the activity leader must possess or be accompanied by staff who possesses current first aid and CPR certification in an approved course. NYSDOH Factsheets listing approved CPR and First Aid certification are available at www.health.ny.gov/environmental/outdoors/camps or by contacting your local health department.

9. What ratio of counselors to campers will be maintained for this activity?

☒ 1:8 for campers younger than 8-years-old ☒ 1:10 for campers 8-years and older

☐ 1:12 (day camps only) ☐ Other (specify):

10. List the required prerequisites for the activity leader (e.g. training, skills, experience, certification):

☒ No specialized prerequisites required

☐ Minimum age: ☐ 18 years-old ☐ 21 years-old or older ☐ Other (specify):

☐ Experience (specify in number of weeks or other quantifiable time period):

☐ Certification(s) (specify):

☐ Training (specify):

☐ Other Skill or knowledge required (specify): 11. Does the activity leader need to possess or be accompanied by staff who possesses current first aid and CPR

certifications for this activity?

☐ Yes ☒ No 12. At a minimum, there must be visual or verbal communications capabilities between campers and counselors at all

times during the activity. Describe any specific duties of the activity leader, counselors and other specialty staff (if any) for this activity:

Help campers with the arts and crafts.

PARTICIPANT PREREQUISITES AND SAFETY PROCEDURES

13. List participant prerequisites, if any (e.g. training, skills, experience, age).

☐ No participant prerequisites

☒ Activity safety orientation including, but not limited to, instruction on the following topics:

Using paints and other crafting elements.

☐ Other (specify):

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14. What safety equipment will be used?

☒ No safety equipment needed ☐ Helmet ☐ Safety goggles ☐ Earplugs

☐ Gloves ☐ Mouth guard ☐ Lifejacket ☐ Shin guards ☐ Long pants

☐ Other (specify):

15. Describe the inspection/maintenance requirements for the required equipment:

☒ No safety equipment/techniques needed

16. What are the rules and/or safety precautions that will be taken during the activity?

No specific rules, beyond normal camp rules.

ACTIVITY: Hiking SUPERVISION

• Each activity at camp must be supervised by an activity leader that is competent in the activity being conducted. Activity leaders of an activity that includes wilderness hiking, camping, rock climbing, horseback riding, bicycling, swimming and/or boating must be at least 18 years of age.

• A minimum of one activity leader and one staff member must supervise activities that occur at locations where additional camp staff assistance is not readily available (within five minutes).

• When the activity is conducted at a location where the camp staff certified in first aid and CPR are not readily available, the activity leader must possess or be accompanied by staff who possesses current first aid and CPR certification in an approved course. NYSDOH Factsheets listing approved CPR and First Aid certification are available at www.health.ny.gov/environmental/outdoors/camps or by contacting your local health department.

17. What ratio of counselors to campers will be maintained for this activity?

☒ 1:8 for campers younger than 8-years-old ☒ 1:10 for campers 8-years and older

☒ 1:12 (day camps only) ☐ Other (specify): 18. List the required prerequisites for the activity leader (e.g. training, skills, experience, certification):

☐ No specialized prerequisites required

☒ Minimum age: ☒ 18 years-old ☐ 21 years-old or older ☐ Other (specify):

☐ Experience (specify in number of weeks or other quantifiable time period):

☐ Certification(s) (specify):

☐ Training (specify):

☐ Other Skill or knowledge required (specify): 19. Does the activity leader need to possess or be accompanied by staff who possesses current first aid and CPR

certifications for this activity?

☒ Yes ☐ No

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20. At a minimum, there must be visual or verbal communications capabilities between campers and counselors at all times during the activity. Describe any specific duties of the activity leader, counselors and other specialty staff (if any) for this activity:

Leading campers on the hike. PARTICIPANT PREREQUISITES AND SAFETY PROCEDURES 21. List participant prerequisites, if any (e.g. training, skills, experience, age).

☒ No participant prerequisites

☐ Activity safety orientation including, but not limited to, instruction on the following topics:

☐ Other (specify): 22. What safety equipment will be used?

☐ No safety equipment needed ☐ Helmet ☐ Safety goggles ☐ Earplugs

☐ Gloves ☐ Mouth guard ☐ Lifejacket ☐ Shin guards ☐ Long pants

☒ Other (specify): trails are not very long and are free of debris and hazards, including poison ivy. We will suggest campers where long sleeves and long pants, but it will not be required. 23. Describe the inspection/maintenance requirements for the required equipment: Trails will be maintained and inspected by the Maintenance staff at the beginning of the camp season. A phone will be taken in case of emergency.

☐ No safety equipment/techniques needed 24. What are the rules and/or safety precautions that will be taken during the activity? Campers must stay in visual range of the counselor at all times, groups going further then a 5 minute walk away from campus (on site) will take a CPR and First Aid Certified person with them.

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ACTIVITY: Organized Games SUPERVISION

• Each activity at camp must be supervised by an activity leader that is competent in the activity being conducted. Activity leaders of an activity that includes wilderness hiking, camping, rock climbing, horseback riding, bicycling, swimming and/or boating must be at least 18 years of age.

• A minimum of one activity leader and one staff member must supervise activities that occur at locations where additional camp staff assistance is not readily available (within five minutes).

• When the activity is conducted at a location where the camp staff certified in first aid and CPR are not readily available, the activity leader must possess or be accompanied by staff who possesses current first aid and CPR certification in an approved course. NYSDOH Factsheets listing approved CPR and First Aid certification are available at www.health.ny.gov/environmental/outdoors/camps or by contacting your local health department.

25. What ratio of counselors to campers will be maintained for this activity?

☒ 1:8 for campers younger than 8-years-old ☒ 1:10 for campers 8-years and older

☒ 1:12 (day camps only) ☐ Other (specify): 26. List the required prerequisites for the activity leader (e.g. training, skills, experience, certification):

☐ No specialized prerequisites required

☐ Minimum age: ☐ 18 years-old ☐ 21 years-old or older ☐ Other (specify):

☒ Experience (specify in number of weeks or other quantifiable time period): 6 weeks

☐ Certification(s) (specify):

☒ Training (specify): rules and guidelines for running games and activities.

☒ Other Skill or knowledge required (specify): Game and activity rules. 27. Does the activity leader need to possess or be accompanied by staff who possesses current first aid and CPR

certifications for this activity?

☒ Yes ☐ No 28. At a minimum, there must be visual or verbal communications capabilities between campers and counselors at all

times during the activity. Describe any specific duties of the activity leader, counselors and other specialty staff (if any) for this activity:

Going over rules and running the games. PARTICIPANT PREREQUISITES AND SAFETY PROCEDURES 29. List participant prerequisites, if any (e.g. training, skills, experience, age).

☒ No participant prerequisites

☐ Activity safety orientation including, but not limited to, instruction on the following topics:

☐ Other (specify): 30. What safety equipment will be used?

☒ No safety equipment needed ☐ Helmet ☐ Safety goggles ☐ Earplugs

☐ Gloves ☐ Mouth guard ☐ Lifejacket ☐ Shin guards ☐ Long pants

☐ Other (specify):

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31. Describe the inspection/maintenance requirements for the required equipment:

☒ No safety equipment/techniques needed 32. What are the rules and/or safety precautions that will be taken during the activity? No specific rules beyond camp rules. ACTIVITY: Tubing SUPERVISION

• Each activity at camp must be supervised by an activity leader that is competent in the activity being conducted. Activity leaders of an activity that includes wilderness hiking, camping, rock climbing, horseback riding, bicycling, swimming and/or boating must be at least 18 years of age.

• A minimum of one activity leader and one staff member must supervise activities that occur at locations where additional camp staff assistance is not readily available (within five minutes).

• When the activity is conducted at a location where the camp staff certified in first aid and CPR are not readily available, the activity leader must possess or be accompanied by staff who possesses current first aid and CPR certification in an approved course. NYSDOH Factsheets listing approved CPR and First Aid certification are available at www.health.ny.gov/environmental/outdoors/camps or by contacting your local health department.

33. What ratio of counselors to campers will be maintained for this activity?

☒ 1:8 for campers younger than 8-years-old ☒ 1:10 for campers 8-years and older

☐ 1:12 (day camps only) ☐ Other (specify): 34. List the required prerequisites for the activity leader (e.g. training, skills, experience, certification):

☐ No specialized prerequisites required

☐ Minimum age: ☐ 18 years-old ☐ 21 years-old or older ☐ Other (specify):

☒ Experience (specify in number of weeks or other quantifiable time period): 5 years

☒ Certification(s) (specify): PV License, Boater Safety Course

☒ Training (specify): Training specific to running and operating the camp boat (e.g. checking oil and fueling the boat, etc)

☒ Other Skill or knowledge required (specify): Knowledge of the lake’s topographical features and general depths. 35. Does the activity leader need to possess or be accompanied by staff who possesses current first aid and CPR

certifications for this activity?

☒ Yes ☐ No 36. At a minimum, there must be visual or verbal communications capabilities between campers and counselors at all

times during the activity. Describe any specific duties of the activity leader, counselors and other specialty staff (if any) for this activity:

Driving the boat. PARTICIPANT PREREQUISITES AND SAFETY PROCEDURES 37. List participant prerequisites, if any (e.g. training, skills, experience, age).

☐ No participant prerequisites

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☒ Activity safety orientation including, but not limited to, instruction on the following topics: Safely getting on and off the tube, hand signals for tube ride (e.g. thumbs up for faster, thumbs down for slower, and hand flat toward boat to stop).

☐ Other (specify): 38. What safety equipment will be used?

☐ No safety equipment needed ☐ Helmet ☐ Safety goggles ☐ Earplugs

☐ Gloves ☐ Mouth guard ☒ Lifejacket ☐ Shin guards ☐ Long pants

☒ Other (specify): Equipment required on boat by Parks and Recs Department (e.g. flares, visual signal, etc). 39. Describe the inspection/maintenance requirements for the required equipment: Daily inspections of boat, including oil, gas, hull, etc.

☐ No safety equipment/techniques needed 40. What are the rules and/or safety precautions that will be taken during the activity? Campers must remain seated on boat when it is in motion, tubers must ride on tube according to the instructions given for a specific tube (e.g. tubes that lay on must be laid on), Campers will never stand on the tube when it is in motion. Tubing maximum 15 miles an hour, speed limit on the lake for boat rides is 30 miles per hour.

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ACTIVITY: Hay Rides SUPERVISION

• Each activity at camp must be supervised by an activity leader that is competent in the activity being conducted. Activity leaders of an activity that includes wilderness hiking, camping, rock climbing, horseback riding, bicycling, swimming and/or boating must be at least 18 years of age.

• A minimum of one activity leader and one staff member must supervise activities that occur at locations where additional camp staff assistance is not readily available (within five minutes).

• When the activity is conducted at a location where the camp staff certified in first aid and CPR are not readily available, the activity leader must possess or be accompanied by staff who possesses current first aid and CPR certification in an approved course. NYSDOH Factsheets listing approved CPR and First Aid certification are available at www.health.ny.gov/environmental/outdoors/camps or by contacting your local health department.

41. What ratio of counselors to campers will be maintained for this activity?

☒ 1:8 for campers younger than 8-years-old ☒ 1:10 for campers 8-years and older

☒ 1:12 (day camps only) ☐ Other (specify): 42. List the required prerequisites for the activity leader (e.g. training, skills, experience, certification):

☐ No specialized prerequisites required

☐ Minimum age: ☐ 18 years-old ☐ 21 years-old or older ☐ Other (specify):

☒ Experience (specify in number of weeks or other quantifiable time period): 5 years

☐ Certification(s) (specify):

☒ Training (specify): training specific to running a farm tractor.

☒ Other Skill or knowledge required (specify): knowledge of where to go and no go on campus with the hay ride. 43. Does the activity leader need to possess or be accompanied by staff who possesses current first aid and CPR

certifications for this activity?

☒ Yes ☐ No 44. At a minimum, there must be visual or verbal communications capabilities between campers and counselors at all

times during the activity. Describe any specific duties of the activity leader, counselors and other specialty staff (if any) for this activity:

Driving the tractor. Loading and offloading of campers. PARTICIPANT PREREQUISITES AND SAFETY PROCEDURES 45. List participant prerequisites, if any (e.g. training, skills, experience, age).

☐ No participant prerequisites

☒ Activity safety orientation including, but not limited to, instruction on the following topics: Safely loading and offloading from hay wagon. Safety while on hay wagon (including not standing while hay wagon is in motion and no horseplay.)

☐ Other (specify): 46. What safety equipment will be used?

☐ No safety equipment needed ☐ Helmet ☐ Safety goggles ☐ Earplugs

☐ Gloves ☐ Mouth guard ☐ Lifejacket ☐ Shin guards ☐ Long pants

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☒ Other (specify): The hay wagon has benches along three sides (not the rear) and high walls around all those same sides. Counselors or other trained staff members will sit at the end of the benches to keep campers from getting close to the back of the hay wagon. 47. Describe the inspection/maintenance requirements for the required equipment: The wagon and tractor are inspected before every use by the driver. This inspection includes looking for safety issues and concerns of any type.

☐ No safety equipment/techniques needed 48. What are the rules and/or safety precautions that will be taken during the activity? Campers will load when directed to and will stay seated for the duration of the ride. No camper will stand when the tractor is moving. Campers will only stand and offload when they are directed to do so by the driver or Counselors. Sides of the trailer are made of wood and keep ACTIVITY: Cooking/Culinary Instruction SUPERVISION

• Each activity at camp must be supervised by an activity leader that is competent in the activity being conducted. Activity leaders of an activity that includes wilderness hiking, camping, rock climbing, horseback riding, bicycling, swimming and/or boating must be at least 18 years of age.

• A minimum of one activity leader and one staff member must supervise activities that occur at locations where additional camp staff assistance is not readily available (within five minutes).

• When the activity is conducted at a location where the camp staff certified in first aid and CPR are not readily available, the activity leader must possess or be accompanied by staff who possesses current first aid and CPR certification in an approved course. NYSDOH Factsheets listing approved CPR and First Aid certification are available at www.health.ny.gov/environmental/outdoors/camps or by contacting your local health department.

49. What ratio of counselors to campers will be maintained for this activity?

☐ 1:8 for campers younger than 8-years-old ☒ 1:10 for campers 8-years and older

☐ 1:12 (day camps only) ☐ Other (specify): 50. List the required prerequisites for the activity leader (e.g. training, skills, experience, certification):

☐ No specialized prerequisites required

☒ Minimum age: ☒ 18 years-old ☐ 21 years-old or older ☐ Other (specify):

☒ Experience (specify in number of weeks or other quantifiable time period): 2 years

☐ Certification(s) (specify):

☒ Training (specify): Culinary Training.

☒ Other Skill or knowledge required (specify): 51. Does the activity leader need to possess or be accompanied by staff who possesses current first aid and CPR

certifications for this activity?

☒ Yes ☐ No

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52. At a minimum, there must be visual or verbal communications capabilities between campers and counselors at all times during the activity. Describe any specific duties of the activity leader, counselors and other specialty staff (if any) for this activity:

PARTICIPANT PREREQUISITES AND SAFETY PROCEDURES 53. List participant prerequisites, if any (e.g. training, skills, experience, age).

☐ No participant prerequisites

☒ Activity safety orientation including, but not limited to, instruction on the following topics: Kitchen/cooking basic safety.

☒ Other (specify): 14 years or older. 54. What safety equipment will be used?

☐ No safety equipment needed ☐ Helmet ☐ Safety goggles ☐ Earplugs

☐ Gloves ☐ Mouth guard ☐ Lifejacket ☐ Shin guards ☐ Long pants

☒ Other (specify): Gloves for food prep. Knife safety gloves for cutting instruction. Hot pads or Hot gloves when working with hot food. 55. Describe the inspection/maintenance requirements for the required equipment: The instructor will inspect all equipment and utensils each day before use.

☐ No safety equipment/techniques needed 56. What are the rules and/or safety precautions that will be taken during the activity? The instructor will give equipment and topic specific safety instructions at the beginning of each lesson or class (e.g. knife safety will be covered before knives are used). Campers will not touch any equipment or kitchen utensils without permission and instruction. No horseplay.

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ACTIVITY: Bounce House SUPERVISION • Each activity at camp must be supervised by an activity leader that is competent in the activity being conducted. Activity leaders of an activity that includes wilderness hiking, camping, rock climbing, horseback riding, bicycling, swimming and/or boating must be at least 18 years of age. • A minimum of one activity leader and one staff member must supervise activities that occur at locations where additional camp staff assistance is not readily available (within five minutes). • When the activity is conducted at a location where the camp staff certified in first aid and CPR are not readily available, the activity leader must possess or be accompanied by staff who possesses current first aid and CPR certification in an approved course. NYSDOH Factsheets listing approved CPR and First Aid certification are available at www.health.ny.gov/environmental/outdoors/camps or by contacting your local health department. 49. What ratio of counselors to campers will be maintained for this activity?

☒ 1:8 for campers younger than 8-years-old ☒ 1:10 for campers 8-years and older

☐ 1:12 (day camps only) ☐ Other (specify): Enter text here. 50. List the required prerequisites for the activity leader (e.g. training, skills, experience, certification):

☒ No specialized prerequisites required

☐ Minimum age: ☐ 18 years-old ☐ 21 years-old or older ☐ Other (specify): Enter text here.

☐ Experience (specify in number of weeks or other quantifiable time period): Enter text here.

☐ Certification(s) (specify): Enter text here.

☐ Training (specify): Enter text here.

☐ Other Skill or knowledge required (specify): Enter text here. 51. Does the activity leader need to possess or be accompanied by staff who possesses current first aid and CPR certifications for this activity?

☐ Yes ☒ No 52. At a minimum, there must be visual or verbal communications capabilities between campers and counselors at all times during the activity. Describe any specific duties of the activity leader, counselors and other specialty staff (if any) for this activity: Counselors, Leader, and staff will oversee the activity and make sure campers follow safety rules and guidelines. PARTICIPANT PREREQUISITES AND SAFETY PROCEDURES 53. List participant prerequisites, if any (e.g. training, skills, experience, age).

☐ No participant prerequisites

☐ Activity safety orientation including, but not limited to, instruction on the following topics:

☒ Other (specify): must be 6&up 54. What safety equipment will be used?

☒ No safety equipment needed ☐ Helmet ☐ Safety goggles ☐ Earplugs

☐ Gloves ☐ Mouth guard ☐ Lifejacket ☐ Shin guards ☐ Long pants

☐ Other (specify): 55. Describe the inspection/maintenance requirements for the required equipment: The bounce house will be inspected before each use by the staff running the activity.

☐ No safety equipment/techniques needed

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56. What are the rules and/or safety precautions that will be taken during the activity? • Only children age 6 and older should use bounce houses. Younger children may not have the balance, coordination or strength to safely enjoy one. • A counselor or adult will always be present to supervise. At a park or other similar setting, a trained staff member must be present to supervise. • Before entering, children will take off their shoes, glasses, and any sharp objects will be removed from their pockets. • No rough housing allowed. • Bounce house will not be used if it is too windy. • The occupancy of the bounce house will stay below the number assigned to the bounce house by the manufacturer (if one is present. If no such number is present or given, then the number will be kept to a minimum to assure safe bouncing).

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